1.0

2015-08-11 10:00:58

  1. 1. Initial Data Load
    1. 1.1. Juana Mariana Gonzales Initial Data Load
      1. 1.1.1. Enter Initial Demographic Data for New Patient Juana Mariana Gonzales, 6-year old
      2. 1.1.2. Enter Initial Immunization Data for Juana Mariana Gonzales: Immunizations from practice
      3. 1.1.3. Enter Initial Immunization Data for Juana Mariana Gonzales from Another Practice
      4. 1.1.4. Enter Initial Immunization Data for Juana Mariana Gonzales Reported by Parent
      5. 1.1.5. Enter Adverse Reaction to the Polio Vaccine
      6. 1.1.6. Enter allergy to egg albumin
  2. 2. Query and Display Response
    1. 2.1. Patient Juana Mariana Gonzales
      1. 2.1.1. Select Patient Juana Mariana Gonzales
      2. 2.1.2. Query Registry for vaccination history and forecast for Juana Mariana Gonzales
      3. 2.1.3. View and Compare response to request for vaccination history for Juana Mariana Gonzales
      4. 2.1.4. Mark first MMRV Dose as Invalid
      5. 2.1.5. View the vaccination forecast for Juana Mariana Gonzales
      6. 2.1.6. Reconcile and import vaccinations from Evaluated History and Forecast for Juana Mariana Gonzales
      7. 2.1.7. View the updated vaccination forecast for Juana Mariana Gonzales
  3. 3. Order and Immunize patient
    1. 3.1. Juana Mariana Gonzales, Enter Orders and Immunizations
      1. 3.1.1. Order IPV and view prior reaction
      2. 3.1.2. IPV Parental Refusal
      3. 3.1.3. Record MMRV Vaccine administration
  4. 4. Transmit Immunization Report
    1. 4.1. Juana Mariana Gonzales Transmit Immunization Report
      1. 4.1.1. Transmit the immunization report to the Immunization Registry
      2. 4.1.2. Receive Acknowledgement
      3. 4.1.3. Record an adverse reaction
      4. 4.1.4. Transmit the updated vaccination report with adverse reaction to the registry
      5. 4.1.5. Receive Acknowledgement

1. Initial Data Load

The initial Data load will consist of the vendor entering data during live interactive testing for 4 patients with various scenarios. The data entry will include demographic data, Immunization histories and specific conditions for each patient.

1.1. Juana Mariana Gonzales Initial Data Load

Demonstrates the ability to record pediatric demographic data, historical vaccinations, and clinical conditions for 6-year old Juana Mariana Gonzales. There are no transactions associated with this test case.

Test Story

Description

The practice site for the scenario is Shoreline Pediatrics. The EHR vendor loads demographic data and clinical history for Juana Mariana Gonzales. The data includes immunizations provided by the practice.

The vendor also enters:

• Two vaccines administered at other sites

   o an influenza vaccine given at a local pharmacy

   o an inactivated polio vaccine given elsewhere and not reported to the registry – the history includes an adverse reaction (febrile seizure) 8 hours after the vaccine was administered

• Adverse reaction to inactivated polio vaccine (febrile seizure) and the date and source of information

• Allergy to egg albumin administered at this site (the registry has different CVX date and lot number information for this vaccine)

NOTE: the historical vaccines will be imported during the Registry query  (e.g. from another practice)

Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data, historical immunizations, and clinical conditions. There is no transaction associated with this test step.

PreCondition

No PreCondition

PostCondition

The EMR has recorded all of the pediatric demographic data, historical immunizations, and clinical conditions  in the record created for Juana Mariana Gonzales using the test data provided.

Test Objectives

No Test Objectives

Evaluation Criteria

No evaluation criteria

Notes to Testers

No Note

1.1.1. Enter Initial Demographic Data for New Patient Juana Mariana Gonzales, 6-year old

Test Step Type: SUT_MANUAL
Juana Mariana Gonzales is entered as a patient in the EMR, including all pediatric demographic information.

Test Story

Description

The EHR vendor loads demographic data for Juana Mariana Gonzales.

Comments

Set-up step evaluating EMR functions for capturing and storing patient pediatric demographic data. There is no transaction associated with this test step.

PreCondition

No PreCondition

PostCondition

The EMR has recorded all of the pediatric demographic  in the record created for Juana Mariana Gonzales.

Test Objectives

Register New Patients: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided, and in particular (Mother's maiden name, multiple birth, birth order), with all required attributes indicated by [Y]:

 

  • Patient ID (previously listed as “Medicaid Number”) - Vendor supplied [Y]
  • Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics [Y]
  • Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied [Y]
  • Patient Name: First - Juana [Y]
  • Patient Name: Middle - Mariana [Y]
  • Patient Date of Birth - 12/23/2009  [Y]
  • Birth Time - 11:05 [N]
  • Patient Gender (Administrative Sex) - F [Y]
  • Patient Multiple Birth Indicator - No [Y]
  • Patient Birth Order -  NA [C]
  • Responsible Person Name: First - Joanna [Y]
  • Responsible Person Name: Middle - Merida [Y]
  • Responsible Person Name: Last - Gonzales [Y]
  • Responsible Person Name: Relationship to Patient - Grandmother (or Grandparent) [Y]
  • Mother’s Name: First - Maria [Y]
  • Mother’s Name: Middle -Merida [Y]
  • Mother’s Name: Last - Gonzales [Y]
  • Mother’s Name: Maiden Last - Acosta [Y]
  • Patient Address: Street - 4345 Standish Way [Y]
  • Patient Address: City - Stamford [Y]
  • Patient Address: State - CT [Y]
  • Patient Address: Country - US [Y]
  • Patient Address: Zipcode - 06903 [Y]
  • Patient Address: County of Residence - Fairfield [N]
  • Race - Other [Y]
  • Ethnicity - Hispanic or Latino [Y]
  • Birthing Facility Name (Birth Delivery Location Address BDL) - Shoreline Hospital 325 Shorline Drive, Stamford Connecticut 06901  [Y - birthing facility name, not address]
  • Patient Birth State - CT [Y]
  • Patient Primary Language - English [Y]
  • Patient Telephone Number - (203) 555-1212 [Y]
  • Patient Telephone Number Type (e.g., home, cell) - home [Y]
  • Patient E-mail Address - jmg@gmail.com [N]
  • Publicity Code  [N]
  • Protection Indicator [N]
  • Protection Indicator Effective Date [N]
  • Immunization Registry Status [N]
  • Preferred Contact Method - Phone  [Y]

Notes to Testers

No Note

1.1.2. Enter Initial Immunization Data for Juana Mariana Gonzales: Immunizations from practice

Test Step Type: SUT_MANUAL
Patient History from the local practice is entered into the EMR.

Test Story

Description

The EHR vendor loads immunization history data from the local practice for Juana Mariana Gonzales.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

PostCondition

The immunization history  the known to the local practice is loaded into the record created for Juana Mariana Gonzales.

Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization data known to the local practice as provided, with all required attributes indicated by [Y]:

Vaccine from Practice HepB    
Entered BY Sandra Molina Y
Ordering Provider Frank Smith Y
Entering Organization Shoreline Pediatrics Y
Administration Notes (Vaccine Event information source) New immunization record (NIP001 00) Y
Date/Time of Start of Administration 1/15/2010 Y
Vaccine Administered hepatitis B vaccine, pediatric or pediatric/adolescent dosage  (CVX 08) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administering Provider Sandra Molina Y
Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901 Y
Lot Number 6352FK1 Y
Substance Expiration Date 10/1/2010 Y
Substance Manufacturer Name GlaxoSmithKline Biologicals SA (MVX SKB) Y
Completion Status CP Y
Route of Administration IM Y
Administration Site Right Thigh Y
     
Vaccine from Practice MMRV    
a. Entered BY J. Martinez Y
b. Ordering Provider Frank Smith Y
c. Entering Organization Shoreline Pediatrics Y
Vaccine Event information source New immunization record (NIP001 00) Y
Value/Text for Vaccine Type  MMRV Y
Date/Time of Start of Administration 10/23/2010 Y
Vaccine Administered measles, mumps, rubella, and varicella virus vaccine Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administration Notes   Y
Administering Provider Sandra Molina Y
Administered-at Location 400 Shoreline Drive, Stamford Connecticut 06901 Y
Lot Number 7W27V7491 Y
Substance Expiration Date 12/15/2010 Y
Substance Manufacturer Name Merck Sharp & Dohme Corp (MVX MSD) Y
Completion Status CP Y
Route of Administration Intramuscular (NCIT IM)  
Administration Site Right Thigh (HL70163 RT)  
     

Notes to Testers

No Note

1.1.3. Enter Initial Immunization Data for Juana Mariana Gonzales from Another Practice

Test Step Type: SUT_MANUAL
Patient History from another practice is entered into the EMR.

Test Story

Description

The EHR vendor loads immunization history data from another practice into the record for Juana Mariana Gonzales.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic  in the record created for Juana Mariana Gonzales.

PostCondition

The immunization history from another practice is loaded into the record created for Juana Mariana Gonzales.

Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization history data from another practice as provided, with all required attributes indicated by [Y]:

Historical Vaccine from Another Practice - Dtap    
Entered BY Sandra Molina Y
Ordering Provider J. Rodriguez Y
Entering Organization Shoreline Pediatrics Y
Vaccine Event information source Historical information - from parent’s written record (NIP001 03) Y
Value/Text for Vaccine Type  DTaP Y
Date/Time of Start of Administration 8/31/2014 Y
Vaccine Administered diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administration Notes   Y
Administering Provider Linda Casera Y
Administered-at Location 4253 Standish Way, Stamford Connecticut 06903 Y
Lot Number D643QS8243 Y
Substance Expiration Date 9/1/2014 Y
Substance Manufacturer Name Sanofi Pasteur Inc (MVX PMC) Y
Completion Status CP Y
Route of Administration Intramuscular (NCIT IM) Y
Administration Site Left Deltoid (HL70163 LD) Y
     
Historical Vaccine from Another Practice - Polio    
Entered BY Sandra Molina Y
Ordering Provider J. Rodriguez Y
Entering Organization Shoreline Pediatrics Y
Vaccine Event information source Historical information - from parent’s written record (NIP001 03) Y
Value/Text for Vaccine Type  DTaP Y
Date/Time of Start of Administration 2/21/2011 Y
Vaccine Administered poliovirus vaccine, inactivated (CVX 10) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administration Notes   Y
Administering Provider Linda Casera Y
Administered-at Location 4253 Standish Way, Stamford Connecticut 06903 Y
Lot Number D335PV9644 Y
Substance Expiration Date 2/22/2011 Y
Substance Manufacturer Name Sanofi Pasteur Inc (MVX PMC) Y
Completion Status CP Y
Route of Administration Intramuscular (NCIT IM) Y
Administration Site Left Deltoid (HL70163 LD) Y
Reaction VXC12^fever of >40.5C (105F) within 48 hours of dose^CDCPHINVS Y

Notes to Testers

No Note

1.1.4. Enter Initial Immunization Data for Juana Mariana Gonzales Reported by Parent

Test Step Type: SUT_MANUAL
Patient History from a pharmacy as reported by the parent is entered into the EMR.

Test Story

Description

The provider enters immunization data from a pharmacy as reported by the parent for Juana Mariana Gonzales.

 

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic data  in the record created for Juana Mariana Gonzales.

PostCondition

The immunization history from the pharmacy as reported by the parent is loaded into the record created for Juana Mariana Gonzales.

Test Objectives

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all immunization history data from the pharmacy as provided by the parent with all required attributes indicated by [Y]:

Historical Vaccine from Pharmacy Reported by Parent    
Entered BY Sandra Molina Y
Ordering Provider Gina Ricci Y
Entering Organization Shoreline Pediatrics Y
Vaccine Event information source Historical information - from other provider (NIP001 02) Y
Value/Text for Vaccine Type  Influenza vaccine Y
Date/Time of Start of Administration 10/15/2013 Y
Vaccine Administered influenza, live, intranasal, quadrivalent (CVX 149) FluMist Quadrivalent (NDC 66019-0301-10)) Y
Administered Amount (of Vaccine) 0.5 Y
Administered Units (of Measure) mL Y
Administration Notes   Y
Administering Provider Gina Ricci Y
Administered-at Location Oceanview Pharmacy, 15 Post Road, Stamford Connecticut 06901 Y
Lot Number 8L4B3423 Y
Substance Expiration Date 7/1/2014 Y
Substance Manufacturer Name MedImmune, LLC (MVX MED) Y
Completion Status CP Y
Route of Administration Nasal (NCIT NS) Y
Administration Site   Y

Notes to Testers

No Note

1.1.5. Enter Adverse Reaction to the Polio Vaccine

Test Step Type: SUT_MANUAL
The EHR captures structured data regarding adverse events as part of the clinical history.

Test Story

Description

The provider documents in the EMR the clinical history of an adverse reaction to the polio vaccine.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

PostCondition

The clinical history of the adverse reaction to the Polio vaccine is documented in the the record created for Juana Mariana Gonzales.

Test Objectives

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all demographic data provided with all required attributes indicated by [Y]:

Adverse Reaction Substance/Agent inactivated polio vaccine (e.g. Poliomyelitis vaccine adverse reaction (disorder) 293117006) Y
Reaction febrile seizure (e.g. Simple febrile seizure (finding) 432354000)
VXC11^convulsions (fits, seizures) within 72 hours of dose^		 Y
Date (of the reaction) 8/31/2014 Y

Notes to Testers

No Note

1.1.6. Enter allergy to egg albumin

Test Step Type: SUT_MANUAL
The EHR captures structured data regarding allergies as part of the clinical history.

Test Story

Description

The provider documents in the EMR the clinical history of an allergy to egg albumin.

Comments

No Comments

PreCondition

The EMR has recorded all of the pediatric demographic in the record created for Juana Mariana Gonzales.

PostCondition

The clinical history of the allergy to egg albumin is documented in the record created for Juana Mariana Gonzales

Test Objectives

Supporting data for: Modify Antigen Recommendations Based on Allergy History: The system notifies the provider of any conflicts between recommended vaccines in the updated forecast and the patient’s active allergies. 

Evaluation Criteria

Evaluation Criteria: Vendor successfully records all clinical allergy data provided with all required attributes indicated by [Y]:

Allergy Sugstance/Agent Egg Albumin Allergy (e.g. 213020009 Egg protein allergy (disorder), Allergy to eggs (disorder) 91930004) Y
Date (allergy status known - e.g. thru testing or date of the allergy) 8/31/2014 Y

Notes to Testers

No Note

2. Query and Display Response

Querying the registry will consist of the vendor creating Z44 messages for each patient to be sent to the registry. The response will be processed as part of the ?Display, Reconcile, Import and Update Immunization Information? activity.

2.1. Patient Juana Mariana Gonzales

EMR Generates a Z44 query to the Immunization Registry to retrieve the Evaluated History and Forecast for Juana Mariana Gonzales.

Test Story

Description
Query the Registry for Juana Mariana Gonzales

Comments
No Comments

PreCondition
Juana Mariana Gonzales is entered as a patient in the EMR with complete Demographic data, Immunization History Data, and Clinical Data according to the steps in the 'Juana Mariana Gonzales Initial Data Load'

PostCondition
A Z44 Query is generated and submitted to the Immunization Registry/Test tool.

Test Objectives
Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry ?on demand? (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother?s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) ? HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Evaluation Criteria
The vendor can produce a valid Z44 query in accordance with the test data correctly and without ommission.
The data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers
No Note

2.1.1. Select Patient Juana Mariana Gonzales

Test Step Type: SUT_MANUAL
Select patient Juana Mariana Gonzales, distinguishing the patient from other patients with similar demographics (similar names).

Test Story

Description

Juana Mariana Gonzales is selected as the patient and her record is opened in the EMR. 

Comments

No Comments

PreCondition

Juana Mariana Gonzales Initial Data Load completed.

PostCondition

Juana Mariana Gonzales is the active working patient in the EMR.

Test Objectives

Select New Patient: The system must allow a user to enter distinguishing information about patients so that providers can uniquely identify patients who have similar sounding names or other similar identifying information.  For example, twins living in the same household will have similar dates of birth, addresses, and may have similar names. EHRs or other clinical software must be able to store information to successfully match with patients in immunization registries, if the information is available. The information includes the mother’s maiden name, whether the patient was part of a multiple birth, and the order of the multiple birth. This information allows the provider to correctly identify the patient and also helps assure a match when the EHR send the patient’s information to external systems such as an immunization registry.

Evaluation Criteria

Tester shall verify that the product can distinguish Juana Mariana Gonzales from similar sounding names using all of the pediatric demographics:

 

  • Patient ID (previously listed as “Medicaid Number”) - Vendor supplied
  • Patient ID: Assigning Authority ID (i.e., owning source)/Facility Name - Shoreline Pediatrics 
  • Patient ID: Type (e.g., medical record number, IIS ID) - Vendor supplied
  • Patient Name: First - Juana 
  • Patient Name: Middle - Mariana 
  • Patient Date of Birth - 12/23/2009 
  • Birth Time - 11:05 
  • Patient Gender (Administrative Sex) - F
  • Patient Multiple Birth Indicator - No 
  • Patient Birth Order -  NA 
  • Responsible Person Name: First - Joanna 
  • Responsible Person Name: Middle - Merida 
  • Responsible Person Name: Last - Gonzales
  • Responsible Person Name: Relationship to Patient - Grandmother (or Grandparent) 
  • Mother’s Name: First - Maria 
  • Mother’s Name: Middle -Merida
  • Mother’s Name: Last - Gonzales
  • Mother’s Name: Maiden Last - Acosta 
  • Patient Address: Street - 4345 Standish Way 
  • Patient Address: City - Stamford
  • Patient Address: State - CT 
  • Patient Address: Country - US 
  • Patient Address: Zipcode - 06903 
  • Patient Address: County of Residence - Fairfield 
  • Race - Other 
  • Ethnicity - Hispanic or Latino 
  • Birthing Facility Name (Birth Delivery Location Address BDL) - Shoreline Hospital 325 Shorline Drive, Stamford Connecticut 06901 
  • Patient Birth State - CT
  • Patient Primary Language - English 
  • Patient Telephone Number - (203) 555-1212 
  • Patient Telephone Number Type (e.g., home, cell) - home 
  • Patient E-mail Address - jmg@gmail.com 
  • Publicity Code  
  • Protection Indicator 
  • Protection Indicator Effective Date 
  • Immunization Registry Status 
  • Preferred Contact Method - Phone  

Notes to Testers

No Note

2.1.2. Query Registry for vaccination history and forecast for Juana Mariana Gonzales

Test Step Type: SUT_INITIATOR
The EMR generates a Z44 query for immunization history and forecast correctly and without omission according to supplied test data.

Test Story

Description

The provider uses the EMR to query the Immunization Registry for an Evaluated History and Forecast based on information known to the Immunization Registry.

Comments

No Comments

PreCondition

Juana Mariana Gonzales Initial Data Load is completed.

PostCondition

The Immunization Registry responds with Evaluated Vaccine History and Forecast for Juana Mariana Gonzales

Test Objectives

Real Time Request/Receive Patient Immunization History: The system sends a request to the public health immunization registry “on demand” (e.g., those without scheduled appointments). The request includes the identifying information the immunization registry needs to match each patient with those in the registry including, if present, the mother’s maiden name, a multiple birth indicator, and the birth order. The request also is sent in a pre-determined format the registry can read and interpret (Query Response Grammar (RSP) – HL7 version 2.5.1 Implementation Guide for Immunization Messaging Release 1.5).

Evaluation Criteria
Tester shall verify that the vendor can produce a valid Z44 query in accordance with the test data correctly and without omission.
Tester shall verify that the data in the message corresponds to the data in the EMR and contains all test data attributes supplied.

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150615001020-0500
MSH.9 Message Type
MSH.9.1 Message Code QBP
MSH.9.2 Trigger Event Q11
MSH.9.3 Message Structure QBP_Q11
MSH.10 Message Control ID 793543
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z44
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

QPD
Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number 123456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Gonzales Test Case Fixed
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Juana Test Case Fixed
QPD.4.3 Second and Further Given Names or Initials Thereof Mariana Test Case Fixed
QPD.4.7 Name Type Code L Test Case Fixed
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname Acosta Test Case Fixed
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code M Test Case Fixed
QPD.6 PatientDateOfBirth
QPD.6.1 Time 200912231105 Test Case Fixed
QPD.7 Patient Sex F Test Case Fixed
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 4345 Standish Way
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation Test Case Fixed
QPD.8.3 City Stamford Test Case Fixed
QPD.8.4 State or Province CT Test Case Fixed
QPD.8.5 Zip or Postal Code 06903 Test Case Fixed
QPD.8.6 Country
QPD.8.7 Address Type L Test Case Fixed
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN Test Case Fixed
QPD.9.3 Telecommunication Equipment Type PH Test Case Fixed
QPD.9.4 Email Address
QPD.9.6 Area/City Code 203 Test Case Fixed
QPD.9.7 Local Number 5551212 Test Case Fixed
QPD.10 Multiple birth indicator
QPD.11 Birth order

RCP
Location Data Element Data Categorization
RCP.1 Query Priority I
RCP.2 Quantity Limited Request
RCP.2.1 Quantity
RCP.2.2 Units
RCP.2.2.1 Identifier
RCP.2.2.2 Text
RCP.2.2.3 Name of Coding System
RCP.2.2.4 Alternate Identifier
RCP.2.2.5 Alternate Text
RCP.2.2.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20150615001020-0500
MSH.9 Message Type
MSH.9.1 Message Code QBP
MSH.9.2 Trigger Event Q11
MSH.9.3 Message Structure QBP_Q11
MSH.10 Message Control ID 793543
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z44
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number 123456
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID MYEHR
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code MR
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Gonzales Test Case Fixed
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Juana Test Case Fixed
QPD.4.3 Second and Further Given Names or Initials Thereof Mariana Test Case Fixed
QPD.4.7 Name Type Code L Test Case Fixed
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname Acosta Test Case Fixed
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code M Test Case Fixed
QPD.6 PatientDateOfBirth
QPD.6.1 Time 200912231105 Test Case Fixed
QPD.7 Patient Sex F Test Case Fixed
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 4345 Standish Way
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation Test Case Fixed
QPD.8.3 City Stamford Test Case Fixed
QPD.8.4 State or Province CT Test Case Fixed
QPD.8.5 Zip or Postal Code 06903 Test Case Fixed
QPD.8.6 Country
QPD.8.7 Address Type L Test Case Fixed
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN Test Case Fixed
QPD.9.3 Telecommunication Equipment Type PH Test Case Fixed
QPD.9.4 Email Address
QPD.9.6 Area/City Code 203 Test Case Fixed
QPD.9.7 Local Number 5551212 Test Case Fixed
QPD.10 Multiple birth indicator
QPD.11 Birth order

Location Data Element Data Categorization
RCP.1 Query Priority I
RCP.2 Quantity Limited Request
RCP.2.1 Quantity
RCP.2.2 Units
RCP.2.2.1 Identifier
RCP.2.2.2 Text
RCP.2.2.3 Name of Coding System
RCP.2.2.4 Alternate Identifier
RCP.2.2.5 Alternate Text
RCP.2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Mariana Gonzales
Date/Time of Birth 12/23/2009
Sex Female
Patient Address 4345 Standish Way Stamford CT
Patient Phone (203)555-1212
Element Data
Patient Name Juana Mariana Gonzales
Date/Time of Birth 12/23/2009
Sex Female
Patient Address 4345 Standish Way Stamford CT
Patient Phone (203)555-1212

2.1.3. View and Compare response to request for vaccination history for Juana Mariana Gonzales

Test Step Type: TA_RESPONDER
The EMR displays the Immunization History results (Z42) returned in response to the Z44 Query and compare to those in the EMR.

Test Story

Description

The Immunization Registry returns an Evaluated History and Forecast (Z42) to the EMR in response to the query for patient (Juana Mariana Gonzales). The provider reviews the immunization history from the registry and compares to the immunization history in the EMR. The provider reconciles the information from these sources, importing information known only to the registry, retaining information that is more accurately reflected in the local EMR:

The physician accesses the record for Juana Mariana Gonzales and:
• Reconciles the EHR vaccine history with the history retrieved from the registry:
o Accepts new vaccines from the registry data
o If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is “invalid” as it was given too early (as notified by the registry)
o Retains the local history for influenza and polio vaccines that are not included in the registry report.

Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR. 

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales)

Test Objectives

Compare Public Health Immunization Registry (IIS) Immunization History to EHR Immunization History: The public health immunization registry has returned the requested immunization history for a patient. The EHR is able to display the immunization history received from the registry as well as the immunization history already present in the EHR so that a user can compare them.  The EHR provides a way for the provider to view both histories, determine what is different (if anything), and update the existing EHR immunization history with new information from the public health registry if he or she chooses to do so. The system must store the new information as structured data as part of the patient’s local immunization history and include the time of the update and the source of the new information.

 
Review Patient Immunization History: To assist with the ordering process, the EHR or other clinical software system allows a user to specify standard views of patient immunization information for each vaccine dose administration, including patient-specific data (e.g., age on dates of administration, etc.).

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document. 

 

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MYIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID MyStateIIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MYEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID Myclinic
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20091130020020-0500
MSH.9 Message Type
MSH.9.1 Message Code RSP
MSH.9.2 Trigger Event K11
MSH.9.3 Message Structure RSP_K11
MSH.10 Message Control ID 7731029
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z42
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name A_Clinic
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID X68
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code AN
MSH.22.10 Organization Identifier A_Clinic1234
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 793543

QAK
Location Data Element Data Categorization
QAK.1 Query Tag 37374859
QAK.2 Query Response Status OK
QAK.3 Message Query Name
QAK.3.1 Identifier Z44
QAK.3.2 Text Request Evaluated History and Forecast
QAK.3.3 Name of Coding System CDCPHINVS
QAK.3.5 Alternate Text
QAK.3.6 Name of Alternate Coding System

QPD
Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Gonzales
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Juana
QPD.4.3 Second and Further Given Names or Initials Thereof Mariana
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname Acosta
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code M
QPD.6 PatientDateOfBirth
QPD.6.1 Time 200912231105
QPD.7 Patient Sex F
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 4345 Standish Way
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Stamford
QPD.8.4 State or Province CT
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 203
QPD.9.7 Local Number 5551212
QPD.10 Multiple birth indicator
QPD.11 Birth order

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 123456
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.3 Patient Identifier List
PID.3.1 ID Number 987633
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYIIS
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code SR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Gonzales
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Juana
PID.5.3 Second and Further Given Names or Initials Thereof Mariana
PID.5.7 Name Type Code L
PID.7 Date/Time of Birth
PID.7.1 Time 200912231105
PID.8 Administrative Sex F
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 4345 Standish Way
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Stamford
PID.11.4 State or Province CT
PID.11.5 Zip or Postal Code 06903
PID.11.6 Country USA
PID.11.7 Address Type L
PID.30 Patient Death Indicator

ORC[*]
ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 6
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 7
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 8
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 9
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 10
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 11
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 12
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 13
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 14
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 15
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 16
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 17
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 18
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 19
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 20
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 21
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 22
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 23
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 24
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 25
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 26
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 27
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 28
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 29
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 30
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 31
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 32
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA[*]
RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091123
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100115
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text hepatitis B vaccine, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101030
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 107
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 6
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 7
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 8
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 9
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 10
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 11
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100221
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 12
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 13
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 14
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100121
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 15
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 16
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 17
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 18
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 19
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 20
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100925
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 21
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101027
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 22
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111002
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount .25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 23
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20120404
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 24
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111123
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 25
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20120523
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 26
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101023
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 27
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20121122
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 28
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 29
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 30
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 31
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 32
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXR[*]
RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 3
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 4
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 5
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 6
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 7
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 8
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 9
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 10
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 11
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 12
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 13
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 14
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 15
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 16
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 17
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 18
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 19
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 20
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 21
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 22
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 23
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 24
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 25
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 26
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 27
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 5
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 6
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 7
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 8
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 11
Location Data Element Data Categorization
OBX.1 Set ID - OBX 9
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 12
Location Data Element Data Categorization
OBX.1 Set ID - OBX 10
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 13
Location Data Element Data Categorization
OBX.1 Set ID - OBX 11
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 14
Location Data Element Data Categorization
OBX.1 Set ID - OBX 12
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 15
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 16
Location Data Element Data Categorization
OBX.1 Set ID - OBX 13
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 17
Location Data Element Data Categorization
OBX.1 Set ID - OBX 14
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 18
Location Data Element Data Categorization
OBX.1 Set ID - OBX 15
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 19
Location Data Element Data Categorization
OBX.1 Set ID - OBX 16
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 20
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 21
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100122

OBX - 22
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20100122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 23
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 24
Location Data Element Data Categorization
OBX.1 Set ID - OBX 17
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 25
Location Data Element Data Categorization
OBX.1 Set ID - OBX 18
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 26
Location Data Element Data Categorization
OBX.1 Set ID - OBX 19
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 27
Location Data Element Data Categorization
OBX.1 Set ID - OBX 20
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 28
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 29
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100323

OBX - 30
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20100323
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 31
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 32
Location Data Element Data Categorization
OBX.1 Set ID - OBX 21
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 31044-1
OBX.3.2 Text Reaction
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100523

OBX - 33
Location Data Element Data Categorization
OBX.1 Set ID - OBX 22
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 34
Location Data Element Data Categorization
OBX.1 Set ID - OBX 23
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 35
Location Data Element Data Categorization
OBX.1 Set ID - OBX 24
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 36
Location Data Element Data Categorization
OBX.1 Set ID - OBX 25
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 37
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 38
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100522

OBX - 39
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20100522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 40
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 41
Location Data Element Data Categorization
OBX.1 Set ID - OBX 26
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 42
Location Data Element Data Categorization
OBX.1 Set ID - OBX 27
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 43
Location Data Element Data Categorization
OBX.1 Set ID - OBX 28
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 44
Location Data Element Data Categorization
OBX.1 Set ID - OBX 29
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 45
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 46
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20110221

OBX - 47
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20110221
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 48
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 49
Location Data Element Data Categorization
OBX.1 Set ID - OBX 30
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 50
Location Data Element Data Categorization
OBX.1 Set ID - OBX 31
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 51
Location Data Element Data Categorization
OBX.1 Set ID - OBX 32
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 52
Location Data Element Data Categorization
OBX.1 Set ID - OBX 33
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 53
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 54
Location Data Element Data Categorization
OBX.1 Set ID - OBX 34
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 55
Location Data Element Data Categorization
OBX.1 Set ID - OBX 35
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 56
Location Data Element Data Categorization
OBX.1 Set ID - OBX 36
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 57
Location Data Element Data Categorization
OBX.1 Set ID - OBX 37
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 58
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 59
Location Data Element Data Categorization
OBX.1 Set ID - OBX 38
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 60
Location Data Element Data Categorization
OBX.1 Set ID - OBX 39
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 61
Location Data Element Data Categorization
OBX.1 Set ID - OBX 40
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 62
Location Data Element Data Categorization
OBX.1 Set ID - OBX 41
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 63
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 64
Location Data Element Data Categorization
OBX.1 Set ID - OBX 42
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 65
Location Data Element Data Categorization
OBX.1 Set ID - OBX 43
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 66
Location Data Element Data Categorization
OBX.1 Set ID - OBX 44
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 67
Location Data Element Data Categorization
OBX.1 Set ID - OBX 45
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 68
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 69
Location Data Element Data Categorization
OBX.1 Set ID - OBX 46
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 70
Location Data Element Data Categorization
OBX.1 Set ID - OBX 47
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 71
Location Data Element Data Categorization
OBX.1 Set ID - OBX 48
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 72
Location Data Element Data Categorization
OBX.1 Set ID - OBX 49
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 73
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 74
Location Data Element Data Categorization
OBX.1 Set ID - OBX 50
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 75
Location Data Element Data Categorization
OBX.1 Set ID - OBX 51
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 76
Location Data Element Data Categorization
OBX.1 Set ID - OBX 52
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 77
Location Data Element Data Categorization
OBX.1 Set ID - OBX 53
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 78
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 79
Location Data Element Data Categorization
OBX.1 Set ID - OBX 54
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 80
Location Data Element Data Categorization
OBX.1 Set ID - OBX 55
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 81
Location Data Element Data Categorization
OBX.1 Set ID - OBX 56
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 82
Location Data Element Data Categorization
OBX.1 Set ID - OBX 57
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 83
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 84
Location Data Element Data Categorization
OBX.1 Set ID - OBX 58
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 85
Location Data Element Data Categorization
OBX.1 Set ID - OBX 59
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 86
Location Data Element Data Categorization
OBX.1 Set ID - OBX 60
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 87
Location Data Element Data Categorization
OBX.1 Set ID - OBX 61
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 88
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 89
Location Data Element Data Categorization
OBX.1 Set ID - OBX 62
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 90
Location Data Element Data Categorization
OBX.1 Set ID - OBX 63
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 91
Location Data Element Data Categorization
OBX.1 Set ID - OBX 64
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 92
Location Data Element Data Categorization
OBX.1 Set ID - OBX 65
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 93
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 94
Location Data Element Data Categorization
OBX.1 Set ID - OBX 66
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 95
Location Data Element Data Categorization
OBX.1 Set ID - OBX 67
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 96
Location Data Element Data Categorization
OBX.1 Set ID - OBX 68
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 97
Location Data Element Data Categorization
OBX.1 Set ID - OBX 69
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 98
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 99
Location Data Element Data Categorization
OBX.1 Set ID - OBX 70
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 100
Location Data Element Data Categorization
OBX.1 Set ID - OBX 71
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 101
Location Data Element Data Categorization
OBX.1 Set ID - OBX 72
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 102
Location Data Element Data Categorization
OBX.1 Set ID - OBX 73
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 103
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 104
Location Data Element Data Categorization
OBX.1 Set ID - OBX 74
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 105
Location Data Element Data Categorization
OBX.1 Set ID - OBX 75
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 106
Location Data Element Data Categorization
OBX.1 Set ID - OBX 76
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 107
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 108
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 109
Location Data Element Data Categorization
OBX.1 Set ID - OBX 78
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 110
Location Data Element Data Categorization
OBX.1 Set ID - OBX 79
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 111
Location Data Element Data Categorization
OBX.1 Set ID - OBX 80
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 112
Location Data Element Data Categorization
OBX.1 Set ID - OBX 81
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 113
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 114
Location Data Element Data Categorization
OBX.1 Set ID - OBX 82
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 115
Location Data Element Data Categorization
OBX.1 Set ID - OBX 83
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 116
Location Data Element Data Categorization
OBX.1 Set ID - OBX 84
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 117
Location Data Element Data Categorization
OBX.1 Set ID - OBX 85
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 118
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 119
Location Data Element Data Categorization
OBX.1 Set ID - OBX 86
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 120
Location Data Element Data Categorization
OBX.1 Set ID - OBX 87
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 121
Location Data Element Data Categorization
OBX.1 Set ID - OBX 88
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 122
Location Data Element Data Categorization
OBX.1 Set ID - OBX 89
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 123
Location Data Element Data Categorization
OBX.1 Set ID - OBX 90
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 124
Location Data Element Data Categorization
OBX.1 Set ID - OBX 91
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 125
Location Data Element Data Categorization
OBX.1 Set ID - OBX 92
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 126
Location Data Element Data Categorization
OBX.1 Set ID - OBX 93
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 127
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20111025
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20111123

OBX - 128
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20111123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 129
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 130
Location Data Element Data Categorization
OBX.1 Set ID - OBX 94
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 131
Location Data Element Data Categorization
OBX.1 Set ID - OBX 95
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 132
Location Data Element Data Categorization
OBX.1 Set ID - OBX 96
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 133
Location Data Element Data Categorization
OBX.1 Set ID - OBX 97
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 134
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20111025
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20120523

OBX - 135
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20120523
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 136
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 137
Location Data Element Data Categorization
OBX.1 Set ID - OBX 98
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 138
Location Data Element Data Categorization
OBX.1 Set ID - OBX 99
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 139
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value N
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 140
Location Data Element Data Categorization
OBX.1 Set ID - OBX 101
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30982-3
OBX.3.2 Text Reason code
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 141
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20100521
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20101023

OBX - 142
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20101023
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 143
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 144
Location Data Element Data Categorization
OBX.1 Set ID - OBX 102
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 145
Location Data Element Data Categorization
OBX.1 Set ID - OBX 103
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 146
Location Data Element Data Categorization
OBX.1 Set ID - OBX 104
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 147
Location Data Element Data Categorization
OBX.1 Set ID - OBX 105
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 148
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 149
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20100521
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20121122

OBX - 150
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20121122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 151
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 152
Location Data Element Data Categorization
OBX.1 Set ID - OBX 106
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 153
Location Data Element Data Categorization
OBX.1 Set ID - OBX 107
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 154
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20100522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 155
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20100522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 156
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20110522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 157
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20110523
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 158
Location Data Element Data Categorization
OBX.1 Set ID - OBX 109
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 159
Location Data Element Data Categorization
OBX.1 Set ID - OBX 106
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 160
Location Data Element Data Categorization
OBX.1 Set ID - OBX 107
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 161
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 162
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 163
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 164
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 165
Location Data Element Data Categorization
OBX.1 Set ID - OBX 109
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 166
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 167
Location Data Element Data Categorization
OBX.1 Set ID - OBX 106
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 168
Location Data Element Data Categorization
OBX.1 Set ID - OBX 107
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 169
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20150901
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 170
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20150901
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 171
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20160131
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 172
Location Data Element Data Categorization
OBX.1 Set ID - OBX 109
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 173
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 174
Location Data Element Data Categorization
OBX.1 Set ID - OBX 110
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 175
Location Data Element Data Categorization
OBX.1 Set ID - OBX 111
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 176
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 177
Location Data Element Data Categorization
OBX.1 Set ID - OBX 112
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 178
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 179
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 180
Location Data Element Data Categorization
OBX.1 Set ID - OBX 113
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 181
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 182
Location Data Element Data Categorization
OBX.1 Set ID - OBX 114
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 183
Location Data Element Data Categorization
OBX.1 Set ID - OBX 115
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 184
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 185
Location Data Element Data Categorization
OBX.1 Set ID - OBX 112
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 186
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 187
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 188
Location Data Element Data Categorization
OBX.1 Set ID - OBX 117
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 189
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MYIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID MyStateIIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MYEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID Myclinic
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20091130020020-0500
MSH.9 Message Type
MSH.9.1 Message Code RSP
MSH.9.2 Trigger Event K11
MSH.9.3 Message Structure RSP_K11
MSH.10 Message Control ID 7731029
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z42
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name A_Clinic
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID X68
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code AN
MSH.22.10 Organization Identifier A_Clinic1234
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 793543

Location Data Element Data Categorization
QAK.1 Query Tag 37374859
QAK.2 Query Response Status OK
QAK.3 Message Query Name
QAK.3.1 Identifier Z44
QAK.3.2 Text Request Evaluated History and Forecast
QAK.3.3 Name of Coding System CDCPHINVS
QAK.3.5 Alternate Text
QAK.3.6 Name of Alternate Coding System

Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Gonzales
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Juana
QPD.4.3 Second and Further Given Names or Initials Thereof Mariana
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname Acosta
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code M
QPD.6 PatientDateOfBirth
QPD.6.1 Time 200912231105
QPD.7 Patient Sex F
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 4345 Standish Way
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Stamford
QPD.8.4 State or Province CT
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 203
QPD.9.7 Local Number 5551212
QPD.10 Multiple birth indicator
QPD.11 Birth order

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 123456
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.3 Patient Identifier List
PID.3.1 ID Number 987633
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYIIS
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code SR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Gonzales
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Juana
PID.5.3 Second and Further Given Names or Initials Thereof Mariana
PID.5.7 Name Type Code L
PID.7 Date/Time of Birth
PID.7.1 Time 200912231105
PID.8 Administrative Sex F
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 4345 Standish Way
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Stamford
PID.11.4 State or Province CT
PID.11.5 Zip or Postal Code 06903
PID.11.6 Country USA
PID.11.7 Address Type L
PID.30 Patient Death Indicator

ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 6
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 7
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 8
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 9
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 10
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 11
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 12
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 13
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 14
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 15
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 16
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 17
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 18
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 19
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 20
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 21
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 22
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 23
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 24
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 25
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 26
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 27
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 28
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 29
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 30
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 31
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 32
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091123
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100115
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text hepatitis B vaccine, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101030
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 107
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 6
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 7
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 8
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 9
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 10
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 11
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100221
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 12
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 13
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 14
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100121
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 15
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 16
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 17
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 18
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 19
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 20
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100925
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 21
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101027
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 22
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111002
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount .25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 23
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20120404
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 24
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111123
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 25
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20120523
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 26
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101023
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 27
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20121122
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 28
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 29
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 30
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 31
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 32
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 3
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 4
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 5
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 6
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 7
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 8
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 9
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 10
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 11
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 12
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 13
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 14
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 15
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 16
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 17
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 18
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 19
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 20
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 21
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 22
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 23
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 24
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 25
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 26
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 27
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 5
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 6
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 7
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 8
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 11
Location Data Element Data Categorization
OBX.1 Set ID - OBX 9
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 12
Location Data Element Data Categorization
OBX.1 Set ID - OBX 10
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 13
Location Data Element Data Categorization
OBX.1 Set ID - OBX 11
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 14
Location Data Element Data Categorization
OBX.1 Set ID - OBX 12
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 15
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 16
Location Data Element Data Categorization
OBX.1 Set ID - OBX 13
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 17
Location Data Element Data Categorization
OBX.1 Set ID - OBX 14
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 18
Location Data Element Data Categorization
OBX.1 Set ID - OBX 15
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 19
Location Data Element Data Categorization
OBX.1 Set ID - OBX 16
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 20
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 21
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100122

OBX - 22
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20100122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 23
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 24
Location Data Element Data Categorization
OBX.1 Set ID - OBX 17
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 25
Location Data Element Data Categorization
OBX.1 Set ID - OBX 18
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 26
Location Data Element Data Categorization
OBX.1 Set ID - OBX 19
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 27
Location Data Element Data Categorization
OBX.1 Set ID - OBX 20
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 28
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 29
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100323

OBX - 30
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20100323
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 31
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 32
Location Data Element Data Categorization
OBX.1 Set ID - OBX 21
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 31044-1
OBX.3.2 Text Reaction
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100523

OBX - 33
Location Data Element Data Categorization
OBX.1 Set ID - OBX 22
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 34
Location Data Element Data Categorization
OBX.1 Set ID - OBX 23
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 35
Location Data Element Data Categorization
OBX.1 Set ID - OBX 24
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 36
Location Data Element Data Categorization
OBX.1 Set ID - OBX 25
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 37
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 38
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100522

OBX - 39
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20100522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 40
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 41
Location Data Element Data Categorization
OBX.1 Set ID - OBX 26
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 42
Location Data Element Data Categorization
OBX.1 Set ID - OBX 27
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 43
Location Data Element Data Categorization
OBX.1 Set ID - OBX 28
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 44
Location Data Element Data Categorization
OBX.1 Set ID - OBX 29
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 45
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 46
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20110221

OBX - 47
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20110221
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 48
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 49
Location Data Element Data Categorization
OBX.1 Set ID - OBX 30
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 50
Location Data Element Data Categorization
OBX.1 Set ID - OBX 31
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 51
Location Data Element Data Categorization
OBX.1 Set ID - OBX 32
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 52
Location Data Element Data Categorization
OBX.1 Set ID - OBX 33
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 53
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 54
Location Data Element Data Categorization
OBX.1 Set ID - OBX 34
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 55
Location Data Element Data Categorization
OBX.1 Set ID - OBX 35
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 56
Location Data Element Data Categorization
OBX.1 Set ID - OBX 36
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 57
Location Data Element Data Categorization
OBX.1 Set ID - OBX 37
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 58
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 59
Location Data Element Data Categorization
OBX.1 Set ID - OBX 38
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 60
Location Data Element Data Categorization
OBX.1 Set ID - OBX 39
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 61
Location Data Element Data Categorization
OBX.1 Set ID - OBX 40
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 62
Location Data Element Data Categorization
OBX.1 Set ID - OBX 41
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 63
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 64
Location Data Element Data Categorization
OBX.1 Set ID - OBX 42
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 65
Location Data Element Data Categorization
OBX.1 Set ID - OBX 43
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 66
Location Data Element Data Categorization
OBX.1 Set ID - OBX 44
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 67
Location Data Element Data Categorization
OBX.1 Set ID - OBX 45
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 68
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 69
Location Data Element Data Categorization
OBX.1 Set ID - OBX 46
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 70
Location Data Element Data Categorization
OBX.1 Set ID - OBX 47
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 71
Location Data Element Data Categorization
OBX.1 Set ID - OBX 48
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 72
Location Data Element Data Categorization
OBX.1 Set ID - OBX 49
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 73
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 74
Location Data Element Data Categorization
OBX.1 Set ID - OBX 50
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 75
Location Data Element Data Categorization
OBX.1 Set ID - OBX 51
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 76
Location Data Element Data Categorization
OBX.1 Set ID - OBX 52
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 77
Location Data Element Data Categorization
OBX.1 Set ID - OBX 53
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 78
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 79
Location Data Element Data Categorization
OBX.1 Set ID - OBX 54
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 80
Location Data Element Data Categorization
OBX.1 Set ID - OBX 55
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 81
Location Data Element Data Categorization
OBX.1 Set ID - OBX 56
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 82
Location Data Element Data Categorization
OBX.1 Set ID - OBX 57
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 83
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 84
Location Data Element Data Categorization
OBX.1 Set ID - OBX 58
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 85
Location Data Element Data Categorization
OBX.1 Set ID - OBX 59
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 86
Location Data Element Data Categorization
OBX.1 Set ID - OBX 60
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 87
Location Data Element Data Categorization
OBX.1 Set ID - OBX 61
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 88
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 89
Location Data Element Data Categorization
OBX.1 Set ID - OBX 62
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 90
Location Data Element Data Categorization
OBX.1 Set ID - OBX 63
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 91
Location Data Element Data Categorization
OBX.1 Set ID - OBX 64
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 92
Location Data Element Data Categorization
OBX.1 Set ID - OBX 65
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 93
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 94
Location Data Element Data Categorization
OBX.1 Set ID - OBX 66
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 95
Location Data Element Data Categorization
OBX.1 Set ID - OBX 67
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 96
Location Data Element Data Categorization
OBX.1 Set ID - OBX 68
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 97
Location Data Element Data Categorization
OBX.1 Set ID - OBX 69
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 98
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 99
Location Data Element Data Categorization
OBX.1 Set ID - OBX 70
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 100
Location Data Element Data Categorization
OBX.1 Set ID - OBX 71
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 101
Location Data Element Data Categorization
OBX.1 Set ID - OBX 72
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 102
Location Data Element Data Categorization
OBX.1 Set ID - OBX 73
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 103
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 104
Location Data Element Data Categorization
OBX.1 Set ID - OBX 74
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 105
Location Data Element Data Categorization
OBX.1 Set ID - OBX 75
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 106
Location Data Element Data Categorization
OBX.1 Set ID - OBX 76
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 107
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 108
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 109
Location Data Element Data Categorization
OBX.1 Set ID - OBX 78
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 110
Location Data Element Data Categorization
OBX.1 Set ID - OBX 79
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 111
Location Data Element Data Categorization
OBX.1 Set ID - OBX 80
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 112
Location Data Element Data Categorization
OBX.1 Set ID - OBX 81
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 113
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 114
Location Data Element Data Categorization
OBX.1 Set ID - OBX 82
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 115
Location Data Element Data Categorization
OBX.1 Set ID - OBX 83
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 116
Location Data Element Data Categorization
OBX.1 Set ID - OBX 84
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 117
Location Data Element Data Categorization
OBX.1 Set ID - OBX 85
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 118
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 119
Location Data Element Data Categorization
OBX.1 Set ID - OBX 86
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 120
Location Data Element Data Categorization
OBX.1 Set ID - OBX 87
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 121
Location Data Element Data Categorization
OBX.1 Set ID - OBX 88
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 122
Location Data Element Data Categorization
OBX.1 Set ID - OBX 89
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 123
Location Data Element Data Categorization
OBX.1 Set ID - OBX 90
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 124
Location Data Element Data Categorization
OBX.1 Set ID - OBX 91
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 125
Location Data Element Data Categorization
OBX.1 Set ID - OBX 92
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 126
Location Data Element Data Categorization
OBX.1 Set ID - OBX 93
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 127
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20111025
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20111123

OBX - 128
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20111123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 129
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 130
Location Data Element Data Categorization
OBX.1 Set ID - OBX 94
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 131
Location Data Element Data Categorization
OBX.1 Set ID - OBX 95
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 132
Location Data Element Data Categorization
OBX.1 Set ID - OBX 96
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 133
Location Data Element Data Categorization
OBX.1 Set ID - OBX 97
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 134
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20111025
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20120523

OBX - 135
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20120523
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 136
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 137
Location Data Element Data Categorization
OBX.1 Set ID - OBX 98
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 138
Location Data Element Data Categorization
OBX.1 Set ID - OBX 99
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 139
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value N
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 140
Location Data Element Data Categorization
OBX.1 Set ID - OBX 101
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30982-3
OBX.3.2 Text Reason code
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 141
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20100521
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20101023

OBX - 142
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20101023
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 143
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 144
Location Data Element Data Categorization
OBX.1 Set ID - OBX 102
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 145
Location Data Element Data Categorization
OBX.1 Set ID - OBX 103
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 146
Location Data Element Data Categorization
OBX.1 Set ID - OBX 104
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 147
Location Data Element Data Categorization
OBX.1 Set ID - OBX 105
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 148
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 149
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20100521
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20121122

OBX - 150
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20121122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 151
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 152
Location Data Element Data Categorization
OBX.1 Set ID - OBX 106
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 153
Location Data Element Data Categorization
OBX.1 Set ID - OBX 107
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 154
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20100522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 155
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20100522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 156
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20110522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 157
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20110523
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 158
Location Data Element Data Categorization
OBX.1 Set ID - OBX 109
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 159
Location Data Element Data Categorization
OBX.1 Set ID - OBX 106
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 160
Location Data Element Data Categorization
OBX.1 Set ID - OBX 107
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 161
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 162
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 163
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 164
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 165
Location Data Element Data Categorization
OBX.1 Set ID - OBX 109
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 166
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 167
Location Data Element Data Categorization
OBX.1 Set ID - OBX 106
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 168
Location Data Element Data Categorization
OBX.1 Set ID - OBX 107
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 169
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20150901
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 170
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20150901
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 171
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20160131
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 172
Location Data Element Data Categorization
OBX.1 Set ID - OBX 109
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 173
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 174
Location Data Element Data Categorization
OBX.1 Set ID - OBX 110
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 175
Location Data Element Data Categorization
OBX.1 Set ID - OBX 111
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 176
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 177
Location Data Element Data Categorization
OBX.1 Set ID - OBX 112
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 178
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 179
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 180
Location Data Element Data Categorization
OBX.1 Set ID - OBX 113
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 181
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 182
Location Data Element Data Categorization
OBX.1 Set ID - OBX 114
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 183
Location Data Element Data Categorization
OBX.1 Set ID - OBX 115
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 184
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 185
Location Data Element Data Categorization
OBX.1 Set ID - OBX 112
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 186
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 187
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 188
Location Data Element Data Categorization
OBX.1 Set ID - OBX 117
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 189
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

2.1.4. Mark first MMRV Dose as Invalid

Test Step Type: SUT_MANUAL
If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is ?invalid? as it was given too early (as notified by the registry).

Test Story

Description

 If the EHR does not already flag the first MMRV as invalid, the provider updates the first MMRV to indicate it is “invalid” as it was given too early (as notified by the registry)

Comments

If the EMR already recognizes the dose as invalid, then this step may be skipped. 

PreCondition

MMRV status indicates that the first MMRV dose is valid.

PostCondition

MMRV status for the first MMRV dose administered on 10/23/2010 is set to invalid.

Test Objectives

dose validity is an important aspect of:

Record Past Immunizations: The EHR or other clinical software system allows providers to enter information about immunizations given elsewhere (e.g., by another doctor, at a public health clinic, pharmacy, etc.) with incomplete details.

Evaluation Criteria

Vendor is able to record that the vaccination dose is invalid with a reason that it was given too early

Notes to Testers

No Note

2.1.5. View the vaccination forecast for Juana Mariana Gonzales

Test Step Type: SUT_MANUAL
Vendor can successfully display the current Immunization Forecast (vaccination names and recommended vaccination dates) as returned by the Registry (Z42).

Test Story

Description

The physician accesses the record for Juana Mariana Gonzales and:

• Displays the registry forecast which includes the need for a second, valid MMRV vaccine and also the need for influenza and polio vaccines (since the registry has no information about them)

Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR. 

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales)

Test Objectives

View Immunization Forecast: The system provides a view of the immunization forecast provided by the public health immunization registry (IIS).  The display includes the forecast from the registry and includes recommended vaccination dates, minimum (earliest) date, ideal date, and maximum (latest) date for each vaccine included in the forecast.

Evaluation Criteria

1. The EMR displays the information returned from the Immunization Registry according to the Juror Document.

2. Verify that All forecast vaccines and dates returned by the registry are displayed to the user. 

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MYIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID MyStateIIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MYEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID Myclinic
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20091130020020-0500
MSH.9 Message Type
MSH.9.1 Message Code RSP
MSH.9.2 Trigger Event K11
MSH.9.3 Message Structure RSP_K11
MSH.10 Message Control ID 7731029
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z42
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name A_Clinic
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID X68
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code AN
MSH.22.10 Organization Identifier A_Clinic1234
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 793543

QAK
Location Data Element Data Categorization
QAK.1 Query Tag 37374859
QAK.2 Query Response Status OK
QAK.3 Message Query Name
QAK.3.1 Identifier Z44
QAK.3.2 Text Request Evaluated History and Forecast
QAK.3.3 Name of Coding System CDCPHINVS
QAK.3.5 Alternate Text
QAK.3.6 Name of Alternate Coding System

QPD
Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Gonzales
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Juana
QPD.4.3 Second and Further Given Names or Initials Thereof Mariana
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname Acosta
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code M
QPD.6 PatientDateOfBirth
QPD.6.1 Time 200912231105
QPD.7 Patient Sex F
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 4345 Standish Way
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Stamford
QPD.8.4 State or Province CT
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 203
QPD.9.7 Local Number 5551212
QPD.10 Multiple birth indicator
QPD.11 Birth order

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 123456
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.3 Patient Identifier List
PID.3.1 ID Number 987633
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYIIS
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code SR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Gonzales
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Juana
PID.5.3 Second and Further Given Names or Initials Thereof Mariana
PID.5.7 Name Type Code L
PID.7 Date/Time of Birth
PID.7.1 Time 200912231105
PID.8 Administrative Sex F
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 4345 Standish Way
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Stamford
PID.11.4 State or Province CT
PID.11.5 Zip or Postal Code 06903
PID.11.6 Country USA
PID.11.7 Address Type L
PID.30 Patient Death Indicator

ORC[*]
ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 6
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 7
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 8
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 9
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 10
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 11
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 12
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 13
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 14
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 15
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 16
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 17
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 18
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 19
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 20
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 21
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 22
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 23
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 24
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 25
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 26
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 27
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 28
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 29
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 30
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 31
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 32
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA[*]
RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091123
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100115
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text hepatitis B vaccine, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101030
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 107
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 6
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 7
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 8
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 9
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 10
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 11
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100221
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 12
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 13
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 14
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100121
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 15
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 16
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 17
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 18
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 19
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 20
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100925
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 21
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101027
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 22
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111002
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount .25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 23
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20120404
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 24
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111123
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 25
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20120523
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 26
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101023
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 27
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20121122
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 28
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 29
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 30
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 31
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 32
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXR[*]
RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 3
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 4
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 5
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 6
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 7
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 8
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 9
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 10
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 11
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 12
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 13
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 14
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 15
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 16
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 17
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 18
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 19
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 20
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 21
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 22
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 23
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 24
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 25
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 26
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 27
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 31
OBX.5.2 Text Hep B Peds NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 5
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 31
OBX.5.2 Text Hep B Peds NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 6
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 7
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 8
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 11
Location Data Element Data Categorization
OBX.1 Set ID - OBX 9
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 31
OBX.5.2 Text Hep B Peds NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 12
Location Data Element Data Categorization
OBX.1 Set ID - OBX 10
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 13
Location Data Element Data Categorization
OBX.1 Set ID - OBX 11
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 14
Location Data Element Data Categorization
OBX.1 Set ID - OBX 12
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 15
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 16
Location Data Element Data Categorization
OBX.1 Set ID - OBX 13
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 17
Location Data Element Data Categorization
OBX.1 Set ID - OBX 14
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 18
Location Data Element Data Categorization
OBX.1 Set ID - OBX 15
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 19
Location Data Element Data Categorization
OBX.1 Set ID - OBX 16
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 20
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 21
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100122

OBX - 22
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20100122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 23
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300003511070517
OBX.5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 24
Location Data Element Data Categorization
OBX.1 Set ID - OBX 17
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 25
Location Data Element Data Categorization
OBX.1 Set ID - OBX 18
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 26
Location Data Element Data Categorization
OBX.1 Set ID - OBX 19
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 27
Location Data Element Data Categorization
OBX.1 Set ID - OBX 20
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 28
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 29
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100323

OBX - 30
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20100323
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 31
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300003511070517
OBX.5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 32
Location Data Element Data Categorization
OBX.1 Set ID - OBX 21
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 31044-1
OBX.3.2 Text Reaction
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC12
OBX.5.2 Text fever of >40.5C (105F) within 48 hours of dose
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100523

OBX - 33
Location Data Element Data Categorization
OBX.1 Set ID - OBX 22
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 34
Location Data Element Data Categorization
OBX.1 Set ID - OBX 23
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 35
Location Data Element Data Categorization
OBX.1 Set ID - OBX 24
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 36
Location Data Element Data Categorization
OBX.1 Set ID - OBX 25
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 37
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 38
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100522

OBX - 39
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20100522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 40
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300003511070517
OBX.5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 41
Location Data Element Data Categorization
OBX.1 Set ID - OBX 26
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 42
Location Data Element Data Categorization
OBX.1 Set ID - OBX 27
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 43
Location Data Element Data Categorization
OBX.1 Set ID - OBX 28
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 44
Location Data Element Data Categorization
OBX.1 Set ID - OBX 29
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 45
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 46
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20110221

OBX - 47
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20110221
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 48
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300003511070517
OBX.5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 49
Location Data Element Data Categorization
OBX.1 Set ID - OBX 30
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 17
OBX.5.2 Text Hib, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 50
Location Data Element Data Categorization
OBX.1 Set ID - OBX 31
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 51
Location Data Element Data Categorization
OBX.1 Set ID - OBX 32
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 52
Location Data Element Data Categorization
OBX.1 Set ID - OBX 33
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 53
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 54
Location Data Element Data Categorization
OBX.1 Set ID - OBX 34
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 17
OBX.5.2 Text Hib, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 55
Location Data Element Data Categorization
OBX.1 Set ID - OBX 35
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 56
Location Data Element Data Categorization
OBX.1 Set ID - OBX 36
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 57
Location Data Element Data Categorization
OBX.1 Set ID - OBX 37
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 58
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 59
Location Data Element Data Categorization
OBX.1 Set ID - OBX 38
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 17
OBX.5.2 Text Hib, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 60
Location Data Element Data Categorization
OBX.1 Set ID - OBX 39
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 61
Location Data Element Data Categorization
OBX.1 Set ID - OBX 40
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 62
Location Data Element Data Categorization
OBX.1 Set ID - OBX 41
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 63
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 64
Location Data Element Data Categorization
OBX.1 Set ID - OBX 42
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 17
OBX.5.2 Text Hib, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 65
Location Data Element Data Categorization
OBX.1 Set ID - OBX 43
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 66
Location Data Element Data Categorization
OBX.1 Set ID - OBX 44
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 67
Location Data Element Data Categorization
OBX.1 Set ID - OBX 45
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 68
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 69
Location Data Element Data Categorization
OBX.1 Set ID - OBX 46
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 10
OBX.5.2 Text poliovirus vaccine, inactivated
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 70
Location Data Element Data Categorization
OBX.1 Set ID - OBX 47
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 71
Location Data Element Data Categorization
OBX.1 Set ID - OBX 48
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 72
Location Data Element Data Categorization
OBX.1 Set ID - OBX 49
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 73
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 74
Location Data Element Data Categorization
OBX.1 Set ID - OBX 50
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 10
OBX.5.2 Text poliovirus vaccine, inactivated
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 75
Location Data Element Data Categorization
OBX.1 Set ID - OBX 51
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 76
Location Data Element Data Categorization
OBX.1 Set ID - OBX 52
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 77
Location Data Element Data Categorization
OBX.1 Set ID - OBX 53
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 78
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 79
Location Data Element Data Categorization
OBX.1 Set ID - OBX 54
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 109
OBX.5.2 Text pneumococcal, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 80
Location Data Element Data Categorization
OBX.1 Set ID - OBX 55
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 81
Location Data Element Data Categorization
OBX.1 Set ID - OBX 56
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 82
Location Data Element Data Categorization
OBX.1 Set ID - OBX 57
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 83
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 84
Location Data Element Data Categorization
OBX.1 Set ID - OBX 58
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 109
OBX.5.2 Text pneumococcal, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 85
Location Data Element Data Categorization
OBX.1 Set ID - OBX 59
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 86
Location Data Element Data Categorization
OBX.1 Set ID - OBX 60
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 87
Location Data Element Data Categorization
OBX.1 Set ID - OBX 61
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 88
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 89
Location Data Element Data Categorization
OBX.1 Set ID - OBX 62
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 109
OBX.5.2 Text pneumococcal, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 90
Location Data Element Data Categorization
OBX.1 Set ID - OBX 63
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 91
Location Data Element Data Categorization
OBX.1 Set ID - OBX 64
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 92
Location Data Element Data Categorization
OBX.1 Set ID - OBX 65
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 93
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 94
Location Data Element Data Categorization
OBX.1 Set ID - OBX 66
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 109
OBX.5.2 Text pneumococcal, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 95
Location Data Element Data Categorization
OBX.1 Set ID - OBX 67
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 96
Location Data Element Data Categorization
OBX.1 Set ID - OBX 68
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 97
Location Data Element Data Categorization
OBX.1 Set ID - OBX 69
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 98
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 99
Location Data Element Data Categorization
OBX.1 Set ID - OBX 70
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 122
OBX.5.2 Text rotavirus, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 100
Location Data Element Data Categorization
OBX.1 Set ID - OBX 71
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 101
Location Data Element Data Categorization
OBX.1 Set ID - OBX 72
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 102
Location Data Element Data Categorization
OBX.1 Set ID - OBX 73
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 103
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 104
Location Data Element Data Categorization
OBX.1 Set ID - OBX 74
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 122
OBX.5.2 Text rotavirus, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 105
Location Data Element Data Categorization
OBX.1 Set ID - OBX 75
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 106
Location Data Element Data Categorization
OBX.1 Set ID - OBX 76
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 107
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 108
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 109
Location Data Element Data Categorization
OBX.1 Set ID - OBX 78
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 110
Location Data Element Data Categorization
OBX.1 Set ID - OBX 79
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 111
Location Data Element Data Categorization
OBX.1 Set ID - OBX 80
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 112
Location Data Element Data Categorization
OBX.1 Set ID - OBX 81
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 113
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 114
Location Data Element Data Categorization
OBX.1 Set ID - OBX 82
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 115
Location Data Element Data Categorization
OBX.1 Set ID - OBX 83
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 116
Location Data Element Data Categorization
OBX.1 Set ID - OBX 84
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 117
Location Data Element Data Categorization
OBX.1 Set ID - OBX 85
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 118
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 119
Location Data Element Data Categorization
OBX.1 Set ID - OBX 86
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 120
Location Data Element Data Categorization
OBX.1 Set ID - OBX 87
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 121
Location Data Element Data Categorization
OBX.1 Set ID - OBX 88
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 122
Location Data Element Data Categorization
OBX.1 Set ID - OBX 89
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 123
Location Data Element Data Categorization
OBX.1 Set ID - OBX 90
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 85
OBX.5.2 Text Hep A, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 124
Location Data Element Data Categorization
OBX.1 Set ID - OBX 91
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 125
Location Data Element Data Categorization
OBX.1 Set ID - OBX 92
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 126
Location Data Element Data Categorization
OBX.1 Set ID - OBX 93
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 127
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20111025
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20111123

OBX - 128
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20111123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 129
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300004211111025
OBX.5.2 Text Hepatitis A VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 130
Location Data Element Data Categorization
OBX.1 Set ID - OBX 94
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 85
OBX.5.2 Text Hep A, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 131
Location Data Element Data Categorization
OBX.1 Set ID - OBX 95
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 132
Location Data Element Data Categorization
OBX.1 Set ID - OBX 96
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 133
Location Data Element Data Categorization
OBX.1 Set ID - OBX 97
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 134
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20111025
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20120523

OBX - 135
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20120523
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 136
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300004211111025
OBX.5.2 Text Hepatitis A VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 137
Location Data Element Data Categorization
OBX.1 Set ID - OBX 98
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 94
OBX.5.2 Text MMRV
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 138
Location Data Element Data Categorization
OBX.1 Set ID - OBX 99
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 139
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value N
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 140
Location Data Element Data Categorization
OBX.1 Set ID - OBX 101
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30982-3
OBX.3.2 Text Reason code
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 264499004
OBX.5.2 Text Early
OBX.5.3 Name of Coding System SCT
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 141
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20100521
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20101023

OBX - 142
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20101023
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 143
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300013411100521
OBX.5.2 Text Measles/Mumps/Rubella/Varicella VIS
OBX.5.3 Name of Coding System
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 144
Location Data Element Data Categorization
OBX.1 Set ID - OBX 102
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 94
OBX.5.2 Text MMRV
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 145
Location Data Element Data Categorization
OBX.1 Set ID - OBX 103
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 146
Location Data Element Data Categorization
OBX.1 Set ID - OBX 104
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 147
Location Data Element Data Categorization
OBX.1 Set ID - OBX 105
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 148
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 149
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20100521
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20121122

OBX - 150
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20121122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 151
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300013411100521
OBX.5.2 Text Measles/Mumps/Rubella/Varicella VIS
OBX.5.3 Name of Coding System
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 152
Location Data Element Data Categorization
OBX.1 Set ID - OBX 106
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 10
OBX.5.2 Text IPV
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 153
Location Data Element Data Categorization
OBX.1 Set ID - OBX 107
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 154
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20100522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 155
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20100522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 156
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20110522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 157
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20110523
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 158
Location Data Element Data Categorization
OBX.1 Set ID - OBX 109
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 159
Location Data Element Data Categorization
OBX.1 Set ID - OBX 106
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 10
OBX.5.2 Text IPV
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 160
Location Data Element Data Categorization
OBX.1 Set ID - OBX 107
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 161
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 162
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 163
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 164
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 165
Location Data Element Data Categorization
OBX.1 Set ID - OBX 109
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 166
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 167
Location Data Element Data Categorization
OBX.1 Set ID - OBX 106
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 168
Location Data Element Data Categorization
OBX.1 Set ID - OBX 107
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 169
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20150901
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 170
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20150901
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 171
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20160131
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 172
Location Data Element Data Categorization
OBX.1 Set ID - OBX 109
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 173
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 174
Location Data Element Data Categorization
OBX.1 Set ID - OBX 110
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 03
OBX.5.2 Text MMR
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 175
Location Data Element Data Categorization
OBX.1 Set ID - OBX 111
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 176
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 177
Location Data Element Data Categorization
OBX.1 Set ID - OBX 112
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 178
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 179
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 180
Location Data Element Data Categorization
OBX.1 Set ID - OBX 113
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 181
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 182
Location Data Element Data Categorization
OBX.1 Set ID - OBX 114
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 21
OBX.5.2 Text Varicella
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 183
Location Data Element Data Categorization
OBX.1 Set ID - OBX 115
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 184
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 185
Location Data Element Data Categorization
OBX.1 Set ID - OBX 112
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 186
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 187
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 188
Location Data Element Data Categorization
OBX.1 Set ID - OBX 117
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 189
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID MYIIS
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID MyStateIIS
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID MYEHR
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID Myclinic
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20091130020020-0500
MSH.9 Message Type
MSH.9.1 Message Code RSP
MSH.9.2 Trigger Event K11
MSH.9.3 Message Structure RSP_K11
MSH.10 Message Control ID 7731029
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type NE
MSH.16 Application Acknowledgment Type NE
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z42
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name A_Clinic
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID X68
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code AN
MSH.22.10 Organization Identifier A_Clinic1234
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA
MSA.2 Message Control ID 793543

Location Data Element Data Categorization
QAK.1 Query Tag 37374859
QAK.2 Query Response Status OK
QAK.3 Message Query Name
QAK.3.1 Identifier Z44
QAK.3.2 Text Request Evaluated History and Forecast
QAK.3.3 Name of Coding System CDCPHINVS
QAK.3.5 Alternate Text
QAK.3.6 Name of Alternate Coding System

Location Data Element Data Categorization
QPD.1 Message Query Name
QPD.1.1 Identifier Z44
QPD.1.2 Text Request Evaluated History and Forecast
QPD.1.3 Name of Coding System CDCPHINVS
QPD.1.5 Alternate Text
QPD.1.6 Name of Alternate Coding System
QPD.2 Query Tag 37374859
QPD.3 PatientList
QPD.3.1 ID Number
QPD.3.3 Check Digit Scheme
QPD.3.4 Assigning Authority
QPD.3.4.1 Namespace ID
QPD.3.4.2 Universal ID
QPD.3.4.3 Universal ID Type
QPD.3.5 Identifier Type Code
QPD.4 PatientName
QPD.4.1 Family Name
QPD.4.1.1 Surname Gonzales
QPD.4.1.2 Own Surname Prefix
QPD.4.1.3 Own Surname
QPD.4.1.4 Surname Prefix From Partner/Spouse
QPD.4.1.5 Surname From Partner/Spouse
QPD.4.2 Given Name Juana
QPD.4.3 Second and Further Given Names or Initials Thereof Mariana
QPD.4.7 Name Type Code L
QPD.5 PatientMotherMaidenName
QPD.5.1 Family Name
QPD.5.1.1 Surname Acosta
QPD.5.1.2 Own Surname Prefix
QPD.5.1.3 Own Surname
QPD.5.1.4 Surname Prefix From Partner/Spouse
QPD.5.1.5 Surname From Partner/Spouse
QPD.5.7 Name Type Code M
QPD.6 PatientDateOfBirth
QPD.6.1 Time 200912231105
QPD.7 Patient Sex F
QPD.8 Patient Address
QPD.8.1 Street Address
QPD.8.1.1 Street or Mailing Address 4345 Standish Way
QPD.8.1.2 Street Name
QPD.8.1.3 Dwelling Number
QPD.8.2 Other Designation
QPD.8.3 City Stamford
QPD.8.4 State or Province CT
QPD.8.5 Zip or Postal Code
QPD.8.6 Country
QPD.8.7 Address Type L
QPD.9 Phone
QPD.9.2 Telecommunication Use Code PRN
QPD.9.3 Telecommunication Equipment Type PH
QPD.9.4 Email Address
QPD.9.6 Area/City Code 203
QPD.9.7 Local Number 5551212
QPD.10 Multiple birth indicator
QPD.11 Birth order

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 123456
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.3 Patient Identifier List
PID.3.1 ID Number 987633
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYIIS
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code SR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Gonzales
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Juana
PID.5.3 Second and Further Given Names or Initials Thereof Mariana
PID.5.7 Name Type Code L
PID.7 Date/Time of Birth
PID.7.1 Time 200912231105
PID.8 Administrative Sex F
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 4345 Standish Way
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Stamford
PID.11.4 State or Province CT
PID.11.5 Zip or Postal Code 06903
PID.11.6 Country USA
PID.11.7 Address Type L
PID.30 Patient Death Indicator

ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 6
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 7
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 8
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 9
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 10
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 11
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 12
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 13
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 14
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 15
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 16
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 17
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 18
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 19
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 20
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 21
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 22
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 23
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 24
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 25
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 26
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 27
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 28
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 29
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 30
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 31
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 32
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197023
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.17 Entering Organization
ORC.17.1 Identifier STIIS
ORC.17.2 Text StateIIS
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091123
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100115
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text hepatitis B vaccine, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101030
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 107
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 6
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 7
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 8
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 9
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 10
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 11
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100221
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 12
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 13
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 14
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100121
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 15
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 16
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 17
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 18
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 19
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 20
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100925
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 21
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101027
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 22
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111002
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount .25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 23
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20120404
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.25
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 24
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111123
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 25
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20120523
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 26
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101023
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 27
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20121122
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.5
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text new immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP

RXA - 28
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 29
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 30
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 31
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXA - 32
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091031
RXA.5 Administered Code
RXA.5.1 Identifier 998
RXA.5.2 Text no vaccine admin
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status NA

RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 3
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 4
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 5
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 6
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 7
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 8
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 9
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 10
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 11
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 12
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 13
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 14
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 15
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 16
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 17
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 18
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 19
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 20
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 21
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 22
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 23
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 24
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 25
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 26
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 27
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 31
OBX.5.2 Text Hep B Peds NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 4
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 5
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 31
OBX.5.2 Text Hep B Peds NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 6
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 7
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 8
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 10
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 11
Location Data Element Data Categorization
OBX.1 Set ID - OBX 9
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 31
OBX.5.2 Text Hep B Peds NOS
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 12
Location Data Element Data Categorization
OBX.1 Set ID - OBX 10
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 13
Location Data Element Data Categorization
OBX.1 Set ID - OBX 11
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 14
Location Data Element Data Categorization
OBX.1 Set ID - OBX 12
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 15
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 16
Location Data Element Data Categorization
OBX.1 Set ID - OBX 13
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 17
Location Data Element Data Categorization
OBX.1 Set ID - OBX 14
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 18
Location Data Element Data Categorization
OBX.1 Set ID - OBX 15
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 19
Location Data Element Data Categorization
OBX.1 Set ID - OBX 16
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 20
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 21
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100122

OBX - 22
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20100122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 23
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300003511070517
OBX.5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 24
Location Data Element Data Categorization
OBX.1 Set ID - OBX 17
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 25
Location Data Element Data Categorization
OBX.1 Set ID - OBX 18
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 26
Location Data Element Data Categorization
OBX.1 Set ID - OBX 19
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 27
Location Data Element Data Categorization
OBX.1 Set ID - OBX 20
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 28
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 29
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100323

OBX - 30
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20100323
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 31
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300003511070517
OBX.5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 32
Location Data Element Data Categorization
OBX.1 Set ID - OBX 21
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 31044-1
OBX.3.2 Text Reaction
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC12
OBX.5.2 Text fever of >40.5C (105F) within 48 hours of dose
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100523

OBX - 33
Location Data Element Data Categorization
OBX.1 Set ID - OBX 22
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 34
Location Data Element Data Categorization
OBX.1 Set ID - OBX 23
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 35
Location Data Element Data Categorization
OBX.1 Set ID - OBX 24
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 36
Location Data Element Data Categorization
OBX.1 Set ID - OBX 25
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 37
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 38
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100522

OBX - 39
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20100522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 40
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300003511070517
OBX.5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 41
Location Data Element Data Categorization
OBX.1 Set ID - OBX 26
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 107
OBX.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 42
Location Data Element Data Categorization
OBX.1 Set ID - OBX 27
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 43
Location Data Element Data Categorization
OBX.1 Set ID - OBX 28
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 44
Location Data Element Data Categorization
OBX.1 Set ID - OBX 29
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 5
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 45
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 46
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20070517
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20110221

OBX - 47
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20110221
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 48
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300003511070517
OBX.5.2 Text Diphtheria/Tetanus/Pertussis (DTaP) VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 49
Location Data Element Data Categorization
OBX.1 Set ID - OBX 30
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 17
OBX.5.2 Text Hib, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 50
Location Data Element Data Categorization
OBX.1 Set ID - OBX 31
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 51
Location Data Element Data Categorization
OBX.1 Set ID - OBX 32
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 52
Location Data Element Data Categorization
OBX.1 Set ID - OBX 33
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 53
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 54
Location Data Element Data Categorization
OBX.1 Set ID - OBX 34
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 17
OBX.5.2 Text Hib, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 55
Location Data Element Data Categorization
OBX.1 Set ID - OBX 35
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 56
Location Data Element Data Categorization
OBX.1 Set ID - OBX 36
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 57
Location Data Element Data Categorization
OBX.1 Set ID - OBX 37
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 58
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 59
Location Data Element Data Categorization
OBX.1 Set ID - OBX 38
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 17
OBX.5.2 Text Hib, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 60
Location Data Element Data Categorization
OBX.1 Set ID - OBX 39
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 61
Location Data Element Data Categorization
OBX.1 Set ID - OBX 40
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 62
Location Data Element Data Categorization
OBX.1 Set ID - OBX 41
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 63
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 64
Location Data Element Data Categorization
OBX.1 Set ID - OBX 42
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 17
OBX.5.2 Text Hib, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 65
Location Data Element Data Categorization
OBX.1 Set ID - OBX 43
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 66
Location Data Element Data Categorization
OBX.1 Set ID - OBX 44
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 67
Location Data Element Data Categorization
OBX.1 Set ID - OBX 45
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 68
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 69
Location Data Element Data Categorization
OBX.1 Set ID - OBX 46
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 10
OBX.5.2 Text poliovirus vaccine, inactivated
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 70
Location Data Element Data Categorization
OBX.1 Set ID - OBX 47
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 71
Location Data Element Data Categorization
OBX.1 Set ID - OBX 48
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 72
Location Data Element Data Categorization
OBX.1 Set ID - OBX 49
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 73
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 74
Location Data Element Data Categorization
OBX.1 Set ID - OBX 50
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 10
OBX.5.2 Text poliovirus vaccine, inactivated
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 75
Location Data Element Data Categorization
OBX.1 Set ID - OBX 51
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 76
Location Data Element Data Categorization
OBX.1 Set ID - OBX 52
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 77
Location Data Element Data Categorization
OBX.1 Set ID - OBX 53
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 78
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 79
Location Data Element Data Categorization
OBX.1 Set ID - OBX 54
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 109
OBX.5.2 Text pneumococcal, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 80
Location Data Element Data Categorization
OBX.1 Set ID - OBX 55
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 81
Location Data Element Data Categorization
OBX.1 Set ID - OBX 56
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 82
Location Data Element Data Categorization
OBX.1 Set ID - OBX 57
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 83
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 84
Location Data Element Data Categorization
OBX.1 Set ID - OBX 58
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 109
OBX.5.2 Text pneumococcal, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 85
Location Data Element Data Categorization
OBX.1 Set ID - OBX 59
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 86
Location Data Element Data Categorization
OBX.1 Set ID - OBX 60
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 87
Location Data Element Data Categorization
OBX.1 Set ID - OBX 61
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 88
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 89
Location Data Element Data Categorization
OBX.1 Set ID - OBX 62
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 109
OBX.5.2 Text pneumococcal, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 90
Location Data Element Data Categorization
OBX.1 Set ID - OBX 63
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 91
Location Data Element Data Categorization
OBX.1 Set ID - OBX 64
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 92
Location Data Element Data Categorization
OBX.1 Set ID - OBX 65
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 93
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 94
Location Data Element Data Categorization
OBX.1 Set ID - OBX 66
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 109
OBX.5.2 Text pneumococcal, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 95
Location Data Element Data Categorization
OBX.1 Set ID - OBX 67
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 96
Location Data Element Data Categorization
OBX.1 Set ID - OBX 68
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 97
Location Data Element Data Categorization
OBX.1 Set ID - OBX 69
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 98
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 99
Location Data Element Data Categorization
OBX.1 Set ID - OBX 70
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 122
OBX.5.2 Text rotavirus, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 100
Location Data Element Data Categorization
OBX.1 Set ID - OBX 71
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 101
Location Data Element Data Categorization
OBX.1 Set ID - OBX 72
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 102
Location Data Element Data Categorization
OBX.1 Set ID - OBX 73
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 103
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 104
Location Data Element Data Categorization
OBX.1 Set ID - OBX 74
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 122
OBX.5.2 Text rotavirus, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 105
Location Data Element Data Categorization
OBX.1 Set ID - OBX 75
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 106
Location Data Element Data Categorization
OBX.1 Set ID - OBX 76
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 107
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 3
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 108
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 109
Location Data Element Data Categorization
OBX.1 Set ID - OBX 78
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 110
Location Data Element Data Categorization
OBX.1 Set ID - OBX 79
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 111
Location Data Element Data Categorization
OBX.1 Set ID - OBX 80
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 112
Location Data Element Data Categorization
OBX.1 Set ID - OBX 81
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 113
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 114
Location Data Element Data Categorization
OBX.1 Set ID - OBX 82
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 115
Location Data Element Data Categorization
OBX.1 Set ID - OBX 83
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 116
Location Data Element Data Categorization
OBX.1 Set ID - OBX 84
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 117
Location Data Element Data Categorization
OBX.1 Set ID - OBX 85
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 118
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 119
Location Data Element Data Categorization
OBX.1 Set ID - OBX 86
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 120
Location Data Element Data Categorization
OBX.1 Set ID - OBX 87
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 121
Location Data Element Data Categorization
OBX.1 Set ID - OBX 88
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 122
Location Data Element Data Categorization
OBX.1 Set ID - OBX 89
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 123
Location Data Element Data Categorization
OBX.1 Set ID - OBX 90
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 85
OBX.5.2 Text Hep A, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 124
Location Data Element Data Categorization
OBX.1 Set ID - OBX 91
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 125
Location Data Element Data Categorization
OBX.1 Set ID - OBX 92
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 126
Location Data Element Data Categorization
OBX.1 Set ID - OBX 93
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 127
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20111025
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20111123

OBX - 128
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20111123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 129
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300004211111025
OBX.5.2 Text Hepatitis A VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 130
Location Data Element Data Categorization
OBX.1 Set ID - OBX 94
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 85
OBX.5.2 Text Hep A, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 131
Location Data Element Data Categorization
OBX.1 Set ID - OBX 95
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 132
Location Data Element Data Categorization
OBX.1 Set ID - OBX 96
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 133
Location Data Element Data Categorization
OBX.1 Set ID - OBX 97
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 134
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20111025
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20120523

OBX - 135
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20120523
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 136
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300004211111025
OBX.5.2 Text Hepatitis A VIS
OBX.5.3 Name of Coding System cdcgs1vis
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 137
Location Data Element Data Categorization
OBX.1 Set ID - OBX 98
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 94
OBX.5.2 Text MMRV
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 138
Location Data Element Data Categorization
OBX.1 Set ID - OBX 99
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 139
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value N
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 140
Location Data Element Data Categorization
OBX.1 Set ID - OBX 101
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30982-3
OBX.3.2 Text Reason code
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier 264499004
OBX.5.2 Text Early
OBX.5.3 Name of Coding System SCT
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 141
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20100521
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20101023

OBX - 142
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20101023
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 143
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300013411100521
OBX.5.2 Text Measles/Mumps/Rubella/Varicella VIS
OBX.5.3 Name of Coding System
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 144
Location Data Element Data Categorization
OBX.1 Set ID - OBX 102
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 94
OBX.5.2 Text MMRV
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 145
Location Data Element Data Categorization
OBX.1 Set ID - OBX 103
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 146
Location Data Element Data Categorization
OBX.1 Set ID - OBX 104
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 1
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 147
Location Data Element Data Categorization
OBX.1 Set ID - OBX 105
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 148
Location Data Element Data Categorization
OBX.1 Set ID - OBX 100
OBX.2 Value Type ID
OBX.3 Observation Identifier
OBX.3.1 Identifier 59781-5
OBX.3.2 Text Dose validity
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 3
OBX.5 Observation Value Y
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 149
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20100521
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20121122

OBX - 150
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS presented
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value 20121122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 151
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 69764-9
OBX.3.2 Text Document type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 253088698300013411100521
OBX.5.2 Text Measles/Mumps/Rubella/Varicella VIS
OBX.5.3 Name of Coding System
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F<
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 152
Location Data Element Data Categorization
OBX.1 Set ID - OBX 106
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 10
OBX.5.2 Text IPV
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 153
Location Data Element Data Categorization
OBX.1 Set ID - OBX 107
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 154
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20100522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 155
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20100522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 156
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20110522
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 157
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20110523
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 158
Location Data Element Data Categorization
OBX.1 Set ID - OBX 109
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 159
Location Data Element Data Categorization
OBX.1 Set ID - OBX 106
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 10
OBX.5.2 Text IPV
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 160
Location Data Element Data Categorization
OBX.1 Set ID - OBX 107
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 161
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 162
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 163
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 164
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 165
Location Data Element Data Categorization
OBX.1 Set ID - OBX 109
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 166
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 167
Location Data Element Data Categorization
OBX.1 Set ID - OBX 106
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 88
OBX.5.2 Text influenza, unspecified formulation
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 168
Location Data Element Data Categorization
OBX.1 Set ID - OBX 107
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 169
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20150901
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 170
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20150901
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 171
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20160131
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 172
Location Data Element Data Categorization
OBX.1 Set ID - OBX 109
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 173
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 4
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 174
Location Data Element Data Categorization
OBX.1 Set ID - OBX 110
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 2
OBX.5 Observation Value
OBX.5.1 Identifier 03
OBX.5.2 Text MMR
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 175
Location Data Element Data Categorization
OBX.1 Set ID - OBX 111
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 176
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 177
Location Data Element Data Categorization
OBX.1 Set ID - OBX 112
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 178
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 179
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 180
Location Data Element Data Categorization
OBX.1 Set ID - OBX 113
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 181
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 182
Location Data Element Data Categorization
OBX.1 Set ID - OBX 114
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 30956-7
OBX.3.2 Text vaccine type
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier 21
OBX.5.2 Text Varicella
OBX.5.3 Name of Coding System CVX
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 183
Location Data Element Data Categorization
OBX.1 Set ID - OBX 115
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 59779-9
OBX.3.2 Text Immunization Schedule used
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC16
OBX.5.2 Text ACIP
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 184
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30981-5
OBX.3.2 Text Earliest date to give
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 185
Location Data Element Data Categorization
OBX.1 Set ID - OBX 112
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 30980-7
OBX.3.2 Text Date vaccination due
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20131122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 186
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59777-3
OBX.3.2 Text Latest date next dose may be given
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151122
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 187
Location Data Element Data Categorization
OBX.1 Set ID - OBX 108
OBX.2 Value Type DT
OBX.3 Observation Identifier
OBX.3.1 Identifier 59778-1
OBX.3.2 Text Date dose is overdue
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 20151123
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

OBX - 188
Location Data Element Data Categorization
OBX.1 Set ID - OBX 117
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 30973-2
OBX.3.2 Text dose number in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20141216

OBX - 189
Location Data Element Data Categorization
OBX.1 Set ID - OBX 77
OBX.2 Value Type NM
OBX.3 Observation Identifier
OBX.3.1 Identifier 59782-3
OBX.3.2 Text number of doses in series
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value 2
OBX.6 Units
OBX.6.1 Identifier NA
OBX.6.2 Text
OBX.6.3 Name of Coding System HL70353
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time

2.1.6. Reconcile and import vaccinations from Evaluated History and Forecast for Juana Mariana Gonzales

Test Step Type: SUT_MANUAL
The Provider uses the EMR to compare the immunization history results (Z42) returned by the Immunization Registry in response to the Z44 Query with the immunization history in the local system, and reconcile (import/update) records.

Test Story

Description

No Description

Comments

No Comments

PreCondition

A Z44 query has been submitted to the Immunization Registry and a Z42 response is provided back to the EMR.and  the response is available in the EMR for reconciliation and import. 

PostCondition

Evaluated Immunization History returned from the registry is reconciled and imported into the patient record (Juana Mariana Gonzales)

Test Objectives

Request/Receive Patient Immunization Data and Identify Source: The EHR or other clinical software is able to store immunization history accepted electronically from other sources (such as a public health immunization registry consistent with HL7 version 2.5.1, Implementation Guide for Immunization Messaging Release 1.5) or communicated by the patient and manually entered by the clinician. When viewing such information, the provider can determine which immunizations were administered by the practice, which were entered manually as patient-reported, and which were accepted electronically from the public health registry.

Evaluation Criteria
1. The user imports returned vaccinations as follows:
a. Vaccinations NOT imported:
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 1/15/2010
measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012
VERIFY that the dose validity is marked as invalid 
b. Vaccinations Imported:
 
hepatitis B vaccine, pediatric or pediatric/adolescent dosage (CVX 08)  administered 10/30/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 1/22/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 3/23/2010,
Including adverse reaction 31044-1 Reaction, VXC12^fever of >40.5C (105F) within 48 hours of dose
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 5/22/2010
diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis antigens (CVX 106) administered 2/21/2011
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 1/22/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 3/23/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 5/22/2010
Haemophilus influenzae type b vaccine, PRP-OMP conjugate (CVX 49) administered 2/21/2011
poliovirus vaccine, inactivated (CVX 10) administered 1/22/2010
poliovirus vaccine, inactivated (CVX 10) administered 3/23/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 1/22/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 3/23/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 5/22/2010
pneumococcal conjugate vaccine, 13 valent (CVX 133) administered 2/21/2011
rotavirus, live, monovalent vaccine (CVX 119) administered 3/23/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 9/25/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/27/2010
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 10/2/2011
Influenza, injectable,quadrivalent, preservative free, pediatric (CVX 161) administered 11/4/2012
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 11/23/2011
hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule (CVX 83) administered 5/23/2012
measles, mumps, rubella, and varicella virus vaccine (CVX 94) administered 11/22/2012
 

Notes to Testers

No Note

2.1.7. View the updated vaccination forecast for Juana Mariana Gonzales

Test Step Type: SUT_MANUAL
Using the reconciled vaccine history information, the EMR displays the current Immunization Forecast to the user for Juana Mariana Gonzales.

Test Story

Description

Once the vaccine history is reconciled in the EMR, the vaccine forecast is updated. 

Comments

No Comments

PreCondition

EMR Vaccine History is Reconciled with Immunization History from the IIS (previous step 'Reconcile and import vaccinations from Evaluated History and Forecast returned by the Registry for Juana Mariana Gonzales').

PostCondition

An updated vaccine forecast based upon the reconciled vaccine history is available to the user. 

Test Objectives

View Reconciled Immunization Forecast: The EHR or other clinical software system has the ability to re-evaluate and update the immunization forecast using a patient’s newly updated immunization history, where the updated forecast results from the reconciliation of immunization data contained in the public health immunization registry with immunization data contained in the EHR. Processing the new forecast can be internal to the EHR or it can use an external forecasting service.

Evaluation Criteria

Tester verifies that the vendor can display the immunization forecast based upon the reconciled vaccination history:

1. Verify that the EMR does not include in reconciled vaccine forecast:
IPV due on 5/22/2010
2. Verify that the EMR includes in reconciled vaccine forecast:
IPV due on 11/22/2013
MMR due on 5/22/2011
Varicella due on 5/22/2011
influenza, unspecified formulation due on 10/21/2015
 

Notes to Testers

No Note

3. Order and Immunize patient

This test will consist of ordering vaccines for the test patients, reviewing any alerts caused by specific scenarios, and documenting vaccinations administered to the patients. NOTE: There are no orders or immunizations in this test plan for Juana Maria Gonzales.

3.1. Juana Mariana Gonzales, Enter Orders and Immunizations

Orders and Immunization events, non-administrations, and alerts presented for current visit.

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

3.1.1. Order IPV and view prior reaction

Test Step Type: SUT_MANUAL
The provider selects to order IPV and views information about the prior febrile seizure post-IPV vaccine.

Test Story

Description

The physician accesses the record for Juana Mariana Gonzales and:

• Selects order for IPV and views information about the prior febrile seizure post-IPV vaccine

Comments

No Comments

PreCondition

Initial Data Load completed with demographic data, vaccination history, and clinical history. Historical Vaccination reconciled and loaded into the EMR.

PostCondition

IPV order entered in patient record. User notified of history of adverse reaction to IPV (febrile seizures).

Test Objectives

Notify of Previous Adverse Event: EHRs and other clinical software systems alert providers to previous adverse events for a specific patient, in order to inform clinical decision-making when providers view an existing immunization record.

Evaluation Criteria

EMR Records the following order information and Alert:

Entered BY:                                       Sandra Molina

Ordering Provider:                               Frank Smith
Entering Organization:                        Shoreline Pediatrics
Vaccine Event information source:        New immunization record (NIP001 00) 
Vaccine Type:                                     IPV (CVX 10)
Date/Time Order was recorded:     Current Date
Alert:                                                 Alerts user to information about the prior febrile seizure post-IPV vaccine


Notes to Testers

No Note

3.1.2. IPV Parental Refusal

Test Step Type: SUT_MANUAL
Documents mother?s refusal for IPV vaccine indicating the parent decision, the reason and makes it permanent.

Test Story

Description

The mother is concerned about administering the IPV due to the prior adverse reaction, and refuses to have the child immunized for IPV. The provider documents mother’s refusal for IPV vaccine indicating the parent decision, the reason and makes it permanent.

Comments

No Comments

PreCondition

Prior Immunization History loaded and reconciled from the Immunization Registry. Order is attempted for IPV. Provider has been alerted to prior adverse reaction to IPV of febrile seizures.

PostCondition

Vaccine non-administration due to parental refusal is documented in the patient record. Deferral is permanent.

Test Objectives

Record Vaccine Administration Deferral: The EHR or other clinical software system allows a user to enter a reason or reasons why a specific immunization was not given to a patient (e.g., due to contraindication, refusal, etc.).  The system also stores that information in a structured way so it can be reported and analyzed as needed.

Evaluation Criteria

EMR documents the non-administration of the IPV due to the parental refulsal:

Substance/Treatment Refusal Reason:        Parental decision (NIP002 00)
Completion Status:                                    RE
Date/Time Vaccine Deferral was recorded:   Current Date
Deferral Reason:                                        Parental decision (NIP002 00)
Deferral Status:                                         Permanent
 

Notes to Testers

No Note

3.1.3. Record MMRV Vaccine administration

Test Step Type: SUT_MANUAL
The provider documents in the EMR all attributes associated with the new vaccine administration.

Test Story

Description

 

 

The nurse administers the the MMRV vaccine
• Documents all required information for each vaccine

 

 

Comments

No Comments

PreCondition

Order is placed for MMRV vaccine.

PostCondition

The MMRV vaccination is recorded in the EMR.

Test Objectives

Record Vaccine Administration: The EHR or other clinical software system records information about each vaccine administered.  The EHR records this information as structured data elements, including, at a minimum: date administered, administering clinician, site of administration (e.g., left arm), immunization type, product, lot number, manufacturer, Vaccine Information Statement date, and quantity of vaccine/dose size.

Evaluation Criteria

EMR Records the following vaccine administration information:

Entered BY:                                 Sandra Molina [Y]

Ordering Provider:                         Frank Smith  [Y]
Entering Organization:                   Shoreline Pediatrics [Y]
Vaccine Event information source:  New immunization record (NIP001 00) [Y] 
   (also known as administration notes)
Vaccine Type: measles, mumps, rubella, and varicella virus vaccine (CVX 94 ), [Y]
Date/Time of Start of Administration:    Current Date [Y]
Vaccine Administered: measles, mumps, rubella, and varicella virus vaccine (CVX 94 ), ProQuad (NDC 00006-4999-00) [Y]
Dose Number:             2
Doses in Series:          2
Administered Amount (of Vaccine):    0.5 [Y]
Administered Units (of Measure):      mL [Y]
Administering Provider:                    Sandra Molina [Y]
Administered-at Location:                400 Shoreline Drive, Stamford Connecticut 06901 [Y]
Lot Number:                                   7W87V3687 [Y]
Substance Expiration Date:             8/15/2015 [Y]
Substance Manufacturer Name:       Merck Sharp & Dohme Corp (MVX MSD) [Y]
Completion Status:                        CP [Y]
Route of Administration:                 Subcutaneous (NCIT C38299, HL70162: SC) [Y]
Administration Site:                        Left Deltoid (HL70162 LD)
 

Notes to Testers

No Note

4. Transmit Immunization Report

This test will consist of generating a Vaccine Update (VXU-Z22) report to the registry for three of the test patients, including updates for vaccines not given. NOTE: There is no Immunization Report in this test plan for Juana Maria Gonzales.

4.1. Juana Mariana Gonzales Transmit Immunization Report

Send the Immunization Report to the Immunization Registry (VXU/Z22) for Juana Mariana Gonzales.

Test Story

Description
Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS.

Comments
The Report must include all newly administered vaccines in any order. the report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS.

PreCondition
The vaccines for the visit have been administered.

PostCondition
No PostCondition

Test Objectives
Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

4.1.1. Transmit the immunization report to the Immunization Registry

Test Step Type: TA_INITIATOR
The EMR send the Immunization Report to the Immunization Registry (VXU/Z22) for updated vaccination information from the visit. This includes all newly administered vaccines and may include historical information updated in the EMR during the visit.

Test Story

Description

Following the vaccinations given during the visit, the EMR transmits an Immunization report to the Immunization Registry using the VXU/Z22. The Vaccination report includes all newly administered vaccines. The report should include vaccines incorrectly recorded in the IIS. The report MAY send the immunizations that the EMR imported from the IIS.

Comments

The Report must include all newly administered vaccines in any order. the report may also include the corrected information where the EMR has different information than the IIS, and may also include the information imported from the IIS.

PreCondition

The vaccines for the visit have been administered.

PostCondition

The Immunization Report has been transmitted to the IIS using a valid Z22 VXU in accordance with the test data correctly and without omission.

Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID Test EHR Application
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID X68
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID NIST Test Iz Reg
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20120701082240-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID NIST-IZ-001.01
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 123456
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.3 Patient Identifier List
PID.3.1 ID Number 987633
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYIIS
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code SR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Gonzales Test Case Fixed
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Juana Test Case Fixed
PID.5.3 Second and Further Given Names or Initials Thereof Mariana Test Case Fixed
PID.5.7 Name Type Code L Test Case Fixed
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname Acosta Test Case Fixed
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code M Test Case Fixed
PID.7 Date/Time of Birth
PID.7.1 Time 200912231105 Test Case Fixed
PID.8 Administrative Sex F Test Case Fixed
PID.10 Race
PID.10.1 Identifier 2131-1 Test Case Fixed
PID.10.2 Text Other Race Test Case Fixed
PID.10.3 Name of Coding System HL70005 Test Case Fixed
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 4345 Standish Way Test Case Fixed
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Stamford Test Case Fixed
PID.11.4 State or Province CT Test Case Fixed
PID.11.5 Zip or Postal Code 06903 Test Case Fixed
PID.11.6 Country USA Test Case Fixed
PID.11.7 Address Type L Test Case Fixed
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 325 Shorline Drive
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Stamford
PID.11.4 State or Province CT Test Case Fixed
PID.11.5 Zip or Postal Code 06901
PID.11.6 Country
PID.11.7 Address Type BDL Test Case Fixed
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN Test Case Fixed
PID.13.3 Telecommunication Equipment Type PH Test Case Fixed
PID.13.4 Email Address
PID.13.6 Area/City Code 203 Test Case Fixed
PID.13.7 Local Number 5551212 Test Case Fixed
PID.22 Ethnic Group
PID.22.1 Identifier 2135-2 Test Case Fixed
PID.22.2 Text Hispanic or Latino Test Case Fixed
PID.22.3 Name of Coding System CDCREC Test Case Fixed
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator
PID.25 Birth Order
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator

PD1
Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 02
PD1.11.2 Text Reminder/Recall - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator
PD1.13 Protection Indicator Effective Date
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20120701
PD1.18 Publicity Code Effective Date 20120701

NK1
Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Gonzales
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Joanna Test Case Fixed
NK1.2.3 Second and Further Given Names or Initials Thereof Merida Test Case Fixed
NK1.2.7 Name Type Code L Test Case Fixed
NK1.3 Relationship
NK1.3.1 Identifier GRP Test Case Fixed
NK1.3.2 Text Grandparent Test Case Fixed
NK1.3.3 Name of Coding System HL70063 Test Case Fixed
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 4345 Standish Way Test Case Fixed
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Stamford Test Case Fixed
NK1.4.4 State or Province CT Test Case Fixed
NK1.4.5 Zip or Postal Code 06901 Test Case Fixed
NK1.4.6 Country
NK1.4.7 Address Type L Test Case Fixed
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN Test Case Fixed
NK1.5.3 Telecommunication Equipment Type PH Test Case Fixed
NK1.5.4 Email Address
NK1.5.6 Area/City Code 203 Test Case Fixed
NK1.5.7 Local Number 5551212 Test Case Fixed

ORC[*]
ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Sirtis
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lisa
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Carter
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Jane
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SH
ORC.17.2 Text Shoreline Hospital
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 6
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L Test Case Fixed
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 7
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 8
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Rodriguez
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name J
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 9
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 10
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 11
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 12
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 13
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 14
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 15
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Rodriguez
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name J
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 16
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 9999
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 17
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 18
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 19
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 20
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 21
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 22
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 23
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 24
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 25
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 26
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Ricci
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Gina
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 27
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina Test Case Fixed
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra Test Case Fixed
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith Test Case Fixed
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank Test Case Fixed
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L Test Case Fixed
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics Test Case Fixed
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 28
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 29
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 30
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name F
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 31
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name F
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 32
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name F
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 33
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina Test Case Fixed
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra Test Case Fixed
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith Test Case Fixed
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank Test Case Fixed
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L Test Case Fixed
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics Test Case Fixed
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA[*]
RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091123
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Sirtis
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lisa
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6332FK33
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101214
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100115
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text hepatitis B vaccine, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Immunization
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6352FK1
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101001
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101030
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6352FK24
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120831
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 107
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS2341
RXA.16 Substance Expiration Date
RXA.16.1 Time 20111130
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS2433
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110904
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 6
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS3255
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101201
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 7
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS249
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110301
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 8
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20140831
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 02
RXA.9.2 Text Historical information - from other provider
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Casera
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Linda
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D643QS8243
RXA.16 Substance Expiration Date
RXA.16.1 Time 20140901
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 9
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M54K9245
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100324
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 10
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M55K3342
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101030
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 11
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M75K4566
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100523
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 12
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M53K5534
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110222
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 13
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D333PV2431
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101004
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 14
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D333PV4344
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100323
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 15
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 02
RXA.9.2 Text Historical information - from other provider
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Casera
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Linda
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D335PV9644
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110222
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 16
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150519
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier 00
RXA.18.2 Text Parental decision
RXA.18.3 Name of Coding System NIP002
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status RE
RXA.21 Action Code - RXA A

RXA - 17
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100121
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P243V3281
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100130
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 18
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P343V8321
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100330
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 19
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P853V2164
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100830
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 20
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P853V58532
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110418
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 21
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RV533
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100215
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 22
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RV932
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100510
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 23
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100925
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D8043IN8734
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110312
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 24
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101027
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D8043IN8734
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110312
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 25
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111002
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D9334IN9333
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120522
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 26
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20131015
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 03
RXA.9.2 Text Historical information - from parents written record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Ricci
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Gina
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 8L4B3423
RXA.16 Substance Expiration Date
RXA.16.1 Time 20140701
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MED
RXA.17.2 Text MedImmune, LLC
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 27
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150715
RXA.5 Administered Code
RXA.5.1 Identifier 149 Test Case Fixed
RXA.5.2 Text influenza, live, intranasal, quadrivalent Test Case Fixed
RXA.5.3 Name of Coding System CVX Test Case Fixed
RXA.5.5 Alternate Text FluMist Quadrivalent Test Case Fixed
RXA.5.6 Name of Alternate Coding System NDC Test Case Fixed
RXA.6 Administered Amount 0.2 Test Case Fixed
RXA.7 Administered Units
RXA.7.1 Identifier mL Test Case Fixed
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM Test Case Fixed
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00 Test Case Fixed
RXA.9.2 Text New immunization record Test Case Fixed
RXA.9.3 Name of Coding System NIP001 Test Case Fixed
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina Test Case Fixed
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra Test Case Fixed
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 8L4B3521 Test Case Fixed
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150815 Test Case Fixed
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MED Test Case Fixed
RXA.17.2 Text MedImmune,LLC Test Case Fixed
RXA.17.3 Name of Coding System MVX Test Case Fixed
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP Test Case Fixed
RXA.21 Action Code - RXA A

RXA - 28
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20121104
RXA.5 Administered Code
RXA.5.1 Identifier 149
RXA.5.2 Text influenza, live, intranasal, quadrivalent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FluMist Quadrivalent
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D9553IN2243
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120430
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 29
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111123
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RT33
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120124
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 30
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20120523
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RT48
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120911
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 31
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101023
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7W27V7491
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101215
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 32
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20121122
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7W87V3452
RXA.16 Substance Expiration Date
RXA.16.1 Time 20130413
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 33
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150715
RXA.5 Administered Code
RXA.5.1 Identifier 94 Test Case Fixed
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine Test Case Fixed
RXA.5.3 Name of Coding System CVX Test Case Fixed
RXA.5.5 Alternate Text ProQuad Test Case Fixed
RXA.5.6 Name of Alternate Coding System NDC Test Case Fixed
RXA.6 Administered Amount 0.5 Test Case Fixed
RXA.7 Administered Units
RXA.7.1 Identifier mL Test Case Fixed
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM Test Case Fixed
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00 Test Case Fixed
RXA.9.2 Text New immunization record Test Case Fixed
RXA.9.3 Name of Coding System NIP001 Test Case Fixed
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina Test Case Fixed
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra Test Case Fixed
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7W87V3687 Test Case Fixed
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150715 Test Case Fixed
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD Test Case Fixed
RXA.17.2 Text Merck Sharp \T\ Dohme Corp Test Case Fixed
RXA.17.3 Name of Coding System MVX Test Case Fixed
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP Test Case Fixed
RXA.21 Action Code - RXA A

RXR[*]
RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 3
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 4
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 5
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 6
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 7
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 8
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 9
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 10
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 11
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 12
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 13
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 14
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 15
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 16
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 17
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 18
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 19
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 20
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 21
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 22
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 23
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 24
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 25
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38284
RXR.1.2 Text Nasal
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Nasal
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier BN
RXR.2.2 Text Bilateral Nares
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 26
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38284 Test Case Fixed
RXR.1.2 Text Nasal Test Case Fixed
RXR.1.3 Name of Coding System NCIT Test Case Fixed
RXR.1.5 Alternate Text Nasal Test Case Fixed
RXR.1.6 Name of Alternate Coding System HL70162 Test Case Fixed
RXR.2 Administration Site
RXR.2.1 Identifier BN
RXR.2.2 Text Bilateral Nares
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 27
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 28
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 29
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 30
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 31
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 32
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299 Test Case Fixed
RXR.1.2 Text Subcutaneous Test Case Fixed
RXR.1.3 Name of Coding System NCIT Test Case Fixed
RXR.1.5 Alternate Text Subcutaneous Test Case Fixed
RXR.1.6 Name of Alternate Coding System HL70162 Test Case Fixed
RXR.2 Administration Site
RXR.2.1 Identifier LD Test Case Fixed
RXR.2.2 Text Left Deltoid Test Case Fixed
RXR.2.3 Name of Coding System HL70163 Test Case Fixed
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 21
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 31044-1
OBX.3.2 Text Reaction
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC12
OBX.5.2 Text fever of >40.5C (105F) within 48 hours of dose
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100522
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9 Test Case Fixed
OBX.3.2 Text VIS Publication Date Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20140819
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7 Test Case Fixed
OBX.3.2 Text VIS Presentation Date Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20150715
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7 Test Case Fixed
OBX.3.2 Text vaccine fund pgm elig cat Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC elig
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9 Test Case Fixed
OBX.3.2 Text VIS Publication Date Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20100521
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7 Test Case Fixed
OBX.3.2 Text VIS Presentation Date Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20150715
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7 Test Case Fixed
OBX.3.2 Text vaccine fund pgm elig cat Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC elig
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID Test EHR Application
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID X68
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID NIST Test Iz Reg
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20120701082240-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID NIST-IZ-001.01
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 123456
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.3 Patient Identifier List
PID.3.1 ID Number 987633
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYIIS
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code SR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Gonzales Test Case Fixed
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Juana Test Case Fixed
PID.5.3 Second and Further Given Names or Initials Thereof Mariana Test Case Fixed
PID.5.7 Name Type Code L Test Case Fixed
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname Acosta Test Case Fixed
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code M Test Case Fixed
PID.7 Date/Time of Birth
PID.7.1 Time 200912231105 Test Case Fixed
PID.8 Administrative Sex F Test Case Fixed
PID.10 Race
PID.10.1 Identifier 2131-1 Test Case Fixed
PID.10.2 Text Other Race Test Case Fixed
PID.10.3 Name of Coding System HL70005 Test Case Fixed
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 4345 Standish Way Test Case Fixed
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Stamford Test Case Fixed
PID.11.4 State or Province CT Test Case Fixed
PID.11.5 Zip or Postal Code 06903 Test Case Fixed
PID.11.6 Country USA Test Case Fixed
PID.11.7 Address Type L Test Case Fixed
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 325 Shorline Drive
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Stamford
PID.11.4 State or Province CT Test Case Fixed
PID.11.5 Zip or Postal Code 06901
PID.11.6 Country
PID.11.7 Address Type BDL Test Case Fixed
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN Test Case Fixed
PID.13.3 Telecommunication Equipment Type PH Test Case Fixed
PID.13.4 Email Address
PID.13.6 Area/City Code 203 Test Case Fixed
PID.13.7 Local Number 5551212 Test Case Fixed
PID.22 Ethnic Group
PID.22.1 Identifier 2135-2 Test Case Fixed
PID.22.2 Text Hispanic or Latino Test Case Fixed
PID.22.3 Name of Coding System CDCREC Test Case Fixed
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator
PID.25 Birth Order
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator

Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 02
PD1.11.2 Text Reminder/Recall - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator
PD1.13 Protection Indicator Effective Date
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20120701
PD1.18 Publicity Code Effective Date 20120701

Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Gonzales
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Joanna Test Case Fixed
NK1.2.3 Second and Further Given Names or Initials Thereof Merida Test Case Fixed
NK1.2.7 Name Type Code L Test Case Fixed
NK1.3 Relationship
NK1.3.1 Identifier GRP Test Case Fixed
NK1.3.2 Text Grandparent Test Case Fixed
NK1.3.3 Name of Coding System HL70063 Test Case Fixed
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 4345 Standish Way Test Case Fixed
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Stamford Test Case Fixed
NK1.4.4 State or Province CT Test Case Fixed
NK1.4.5 Zip or Postal Code 06901 Test Case Fixed
NK1.4.6 Country
NK1.4.7 Address Type L Test Case Fixed
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN Test Case Fixed
NK1.5.3 Telecommunication Equipment Type PH Test Case Fixed
NK1.5.4 Email Address
NK1.5.6 Area/City Code 203 Test Case Fixed
NK1.5.7 Local Number 5551212 Test Case Fixed

ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Sirtis
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lisa
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Carter
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Jane
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SH
ORC.17.2 Text Shoreline Hospital
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 6
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L Test Case Fixed
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 7
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 8
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Rodriguez
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name J
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 9
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 10
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 11
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 12
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 13
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 14
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 15
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Rodriguez
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name J
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 16
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 9999
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 17
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 18
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 19
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 20
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 21
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 22
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 23
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 24
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 25
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 26
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Ricci
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Gina
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 27
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina Test Case Fixed
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra Test Case Fixed
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith Test Case Fixed
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank Test Case Fixed
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L Test Case Fixed
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics Test Case Fixed
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 28
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 29
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 30
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name F
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 31
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name F
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 32
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name F
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 33
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina Test Case Fixed
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra Test Case Fixed
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith Test Case Fixed
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank Test Case Fixed
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L Test Case Fixed
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics Test Case Fixed
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091123
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Sirtis
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lisa
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6332FK33
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101214
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100115
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text hepatitis B vaccine, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Immunization
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6352FK1
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101001
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101030
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6352FK24
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120831
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 107
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS2341
RXA.16 Substance Expiration Date
RXA.16.1 Time 20111130
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS2433
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110904
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 6
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS3255
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101201
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 7
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS249
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110301
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 8
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20140831
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 02
RXA.9.2 Text Historical information - from other provider
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Casera
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Linda
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D643QS8243
RXA.16 Substance Expiration Date
RXA.16.1 Time 20140901
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 9
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M54K9245
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100324
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 10
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M55K3342
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101030
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 11
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M75K4566
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100523
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 12
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M53K5534
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110222
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 13
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D333PV2431
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101004
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 14
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D333PV4344
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100323
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 15
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 02
RXA.9.2 Text Historical information - from other provider
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Casera
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Linda
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D335PV9644
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110222
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 16
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150519
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier 00
RXA.18.2 Text Parental decision
RXA.18.3 Name of Coding System NIP002
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status RE
RXA.21 Action Code - RXA A

RXA - 17
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100121
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P243V3281
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100130
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 18
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P343V8321
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100330
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 19
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P853V2164
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100830
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 20
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P853V58532
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110418
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 21
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RV533
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100215
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 22
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RV932
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100510
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 23
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100925
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D8043IN8734
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110312
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 24
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101027
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D8043IN8734
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110312
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 25
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111002
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D9334IN9333
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120522
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 26
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20131015
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 03
RXA.9.2 Text Historical information - from parents written record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Ricci
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Gina
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 8L4B3423
RXA.16 Substance Expiration Date
RXA.16.1 Time 20140701
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MED
RXA.17.2 Text MedImmune, LLC
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 27
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150715
RXA.5 Administered Code
RXA.5.1 Identifier 149 Test Case Fixed
RXA.5.2 Text influenza, live, intranasal, quadrivalent Test Case Fixed
RXA.5.3 Name of Coding System CVX Test Case Fixed
RXA.5.5 Alternate Text FluMist Quadrivalent Test Case Fixed
RXA.5.6 Name of Alternate Coding System NDC Test Case Fixed
RXA.6 Administered Amount 0.2 Test Case Fixed
RXA.7 Administered Units
RXA.7.1 Identifier mL Test Case Fixed
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM Test Case Fixed
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00 Test Case Fixed
RXA.9.2 Text New immunization record Test Case Fixed
RXA.9.3 Name of Coding System NIP001 Test Case Fixed
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina Test Case Fixed
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra Test Case Fixed
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 8L4B3521 Test Case Fixed
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150815 Test Case Fixed
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MED Test Case Fixed
RXA.17.2 Text MedImmune,LLC Test Case Fixed
RXA.17.3 Name of Coding System MVX Test Case Fixed
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP Test Case Fixed
RXA.21 Action Code - RXA A

RXA - 28
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20121104
RXA.5 Administered Code
RXA.5.1 Identifier 149
RXA.5.2 Text influenza, live, intranasal, quadrivalent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FluMist Quadrivalent
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D9553IN2243
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120430
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 29
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111123
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RT33
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120124
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 30
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20120523
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RT48
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120911
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 31
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101023
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7W27V7491
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101215
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 32
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20121122
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7W87V3452
RXA.16 Substance Expiration Date
RXA.16.1 Time 20130413
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 33
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150715
RXA.5 Administered Code
RXA.5.1 Identifier 94 Test Case Fixed
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine Test Case Fixed
RXA.5.3 Name of Coding System CVX Test Case Fixed
RXA.5.5 Alternate Text ProQuad Test Case Fixed
RXA.5.6 Name of Alternate Coding System NDC Test Case Fixed
RXA.6 Administered Amount 0.5 Test Case Fixed
RXA.7 Administered Units
RXA.7.1 Identifier mL Test Case Fixed
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM Test Case Fixed
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00 Test Case Fixed
RXA.9.2 Text New immunization record Test Case Fixed
RXA.9.3 Name of Coding System NIP001 Test Case Fixed
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina Test Case Fixed
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra Test Case Fixed
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7W87V3687 Test Case Fixed
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150715 Test Case Fixed
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD Test Case Fixed
RXA.17.2 Text Merck Sharp \T\ Dohme Corp Test Case Fixed
RXA.17.3 Name of Coding System MVX Test Case Fixed
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP Test Case Fixed
RXA.21 Action Code - RXA A

RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 3
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 4
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 5
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 6
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 7
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 8
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 9
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 10
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 11
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 12
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 13
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 14
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 15
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 16
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 17
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 18
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 19
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 20
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 21
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 22
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 23
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 24
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 25
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38284
RXR.1.2 Text Nasal
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Nasal
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier BN
RXR.2.2 Text Bilateral Nares
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 26
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38284 Test Case Fixed
RXR.1.2 Text Nasal Test Case Fixed
RXR.1.3 Name of Coding System NCIT Test Case Fixed
RXR.1.5 Alternate Text Nasal Test Case Fixed
RXR.1.6 Name of Alternate Coding System HL70162 Test Case Fixed
RXR.2 Administration Site
RXR.2.1 Identifier BN
RXR.2.2 Text Bilateral Nares
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 27
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 28
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 29
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 30
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 31
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 32
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299 Test Case Fixed
RXR.1.2 Text Subcutaneous Test Case Fixed
RXR.1.3 Name of Coding System NCIT Test Case Fixed
RXR.1.5 Alternate Text Subcutaneous Test Case Fixed
RXR.1.6 Name of Alternate Coding System HL70162 Test Case Fixed
RXR.2 Administration Site
RXR.2.1 Identifier LD Test Case Fixed
RXR.2.2 Text Left Deltoid Test Case Fixed
RXR.2.3 Name of Coding System HL70163 Test Case Fixed
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 21
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 31044-1
OBX.3.2 Text Reaction
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier VXC12
OBX.5.2 Text fever of >40.5C (105F) within 48 hours of dose
OBX.5.3 Name of Coding System CDCPHINVS
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100522
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9 Test Case Fixed
OBX.3.2 Text VIS Publication Date Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20140819
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7 Test Case Fixed
OBX.3.2 Text VIS Presentation Date Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20150715
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7 Test Case Fixed
OBX.3.2 Text vaccine fund pgm elig cat Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC elig
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9 Test Case Fixed
OBX.3.2 Text VIS Publication Date Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20100521
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7 Test Case Fixed
OBX.3.2 Text VIS Presentation Date Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20150715
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7 Test Case Fixed
OBX.3.2 Text vaccine fund pgm elig cat Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Identifier V01
OBX.5.2 Text Not VFC elig
OBX.5.3 Name of Coding System HL70064
OBX.5.5 Alternate Text
OBX.5.6 Name of Alternate Coding System
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Mariana Gonzales
Mother's Maiden Name Maria Acosta
ID Number 123456 987633
Date/Time of Birth 12/23/2009
Administrative Sex Female
Patient Address 4345 Standish Way Stamford CT 06903 USA
Patient Address 1 325 Shorline Drive Stamford CT 06901
Local Number (203)555-1212
Race Other Race
Ethnic Group Hispanic or Latino
Birth Order
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 07/01/2012
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 07/01/2012
Protection Indicator
Protection Indicator Effective Date
Guardian or Responsible Party
Element Data
Name Joanna Merida Gonzales
Relationship Grandparent
Address 4345 Standish Way Stamford CT 06901
Phone Number (203)555-1212

Vaccine Administration Information[*]
Vaccine Administration Information - 1
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 11/23/2009
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Lisa Sirtis
Substance Lot Number 6332FK33
Substance Expiration Date 12/14/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Vaccine Administration Information - 2
Element Data
Administered Code hepatitis B vaccine, unspecified formulation
Date/Time Start of Administration 01/15/2010
Administered Amount 999
Administered Units
Administration Notes Historical Immunization
Administering Provider Sandra Molina
Substance Lot Number 6352FK1
Substance Expiration Date 10/01/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information - 3
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 10/30/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6352FK24
Substance Expiration Date 08/31/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 4
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2341
Substance Expiration Date 11/30/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 5
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2433
Substance Expiration Date 09/04/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 6
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS3255
Substance Expiration Date 12/01/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data
Reaction fever of >40.5C (105F) within 48 hours of dose

Vaccine Administration Information - 7
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS249
Substance Expiration Date 03/01/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 8
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 08/31/2014
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D643QS8243
Substance Expiration Date 09/01/2014
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information - 9
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M54K9245
Substance Expiration Date 03/24/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 10
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M55K3342
Substance Expiration Date 10/30/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 11
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M75K4566
Substance Expiration Date 05/23/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 12
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M53K5534
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 13
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV2431
Substance Expiration Date 10/04/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 14
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV4344
Substance Expiration Date 03/23/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 15
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D335PV9644
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information - 16
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 05/19/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Completion Status RE
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information - 17
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/21/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P243V3281
Substance Expiration Date 01/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 18
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P343V8321
Substance Expiration Date 03/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 19
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V2164
Substance Expiration Date 08/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 20
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V58532
Substance Expiration Date 04/18/2011
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 21
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV533
Substance Expiration Date 02/15/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 22
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV932
Substance Expiration Date 05/10/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 23
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 09/25/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 24
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/27/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 25
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/02/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9334IN9333
Substance Expiration Date 05/22/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 26
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/15/2013
Administered Amount 999
Administered Units
Administration Notes Historical information - from parents written record
Administering Provider Gina Ricci
Substance Lot Number 8L4B3423
Substance Expiration Date 07/01/2014
Substance Manufacturer Name MedImmune, LLC
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Gina Ricci

Vaccine Administration Information - 27
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 07/15/2015
Administered Amount 0.2
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 8L4B3521
Substance Expiration Date 08/15/2015
Substance Manufacturer Name MedImmune,LLC
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Observations
Element Data
VIS Publication Date 08/19/2014
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig

Vaccine Administration Information - 28
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 11/04/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9553IN2243
Substance Expiration Date 04/30/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 29
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 11/23/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT33
Substance Expiration Date 01/24/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 30
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 05/23/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT48
Substance Expiration Date 09/11/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information - 31
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 10/23/2010
Administered Amount 999
Administered Units
Administration Notes historical
Administering Provider J Martinez
Substance Lot Number 7W27V7491
Substance Expiration Date 12/15/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information - 32
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 11/22/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7W87V3452
Substance Expiration Date 04/13/2013
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information - 33
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 07/15/2015
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 7W87V3687
Substance Expiration Date 07/15/2015
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Observations
Element Data
VIS Publication Date 05/21/2010
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig
Element Data
Patient Name Juana Mariana Gonzales
Mother's Maiden Name Maria Acosta
ID Number 123456 987633
Date/Time of Birth 12/23/2009
Administrative Sex Female
Patient Address 4345 Standish Way Stamford CT 06903 USA
Patient Address 1 325 Shorline Drive Stamford CT 06901
Local Number (203)555-1212
Race Other Race
Ethnic Group Hispanic or Latino
Birth Order
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 07/01/2012
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 07/01/2012
Protection Indicator
Protection Indicator Effective Date
Element Data
Name Joanna Merida Gonzales
Relationship Grandparent
Address 4345 Standish Way Stamford CT 06901
Phone Number (203)555-1212
Vaccine Administration Information - 1
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 11/23/2009
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Lisa Sirtis
Substance Lot Number 6332FK33
Substance Expiration Date 12/14/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

 Vaccine Administration Information - 2
Element Data
Administered Code hepatitis B vaccine, unspecified formulation
Date/Time Start of Administration 01/15/2010
Administered Amount 999
Administered Units
Administration Notes Historical Immunization
Administering Provider Sandra Molina
Substance Lot Number 6352FK1
Substance Expiration Date 10/01/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

 Vaccine Administration Information - 3
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 10/30/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6352FK24
Substance Expiration Date 08/31/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 4
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2341
Substance Expiration Date 11/30/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 5
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2433
Substance Expiration Date 09/04/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 6
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS3255
Substance Expiration Date 12/01/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data
Reaction fever of >40.5C (105F) within 48 hours of dose

 Vaccine Administration Information - 7
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS249
Substance Expiration Date 03/01/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 8
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 08/31/2014
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D643QS8243
Substance Expiration Date 09/01/2014
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

 Vaccine Administration Information - 9
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M54K9245
Substance Expiration Date 03/24/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 10
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M55K3342
Substance Expiration Date 10/30/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 11
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M75K4566
Substance Expiration Date 05/23/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 12
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M53K5534
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 13
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV2431
Substance Expiration Date 10/04/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 14
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV4344
Substance Expiration Date 03/23/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 15
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D335PV9644
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

 Vaccine Administration Information - 16
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 05/19/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Completion Status RE
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

 Vaccine Administration Information - 17
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/21/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P243V3281
Substance Expiration Date 01/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 18
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P343V8321
Substance Expiration Date 03/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 19
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V2164
Substance Expiration Date 08/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 20
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V58532
Substance Expiration Date 04/18/2011
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 21
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV533
Substance Expiration Date 02/15/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 22
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV932
Substance Expiration Date 05/10/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 23
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 09/25/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 24
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/27/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 25
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/02/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9334IN9333
Substance Expiration Date 05/22/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 26
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/15/2013
Administered Amount 999
Administered Units
Administration Notes Historical information - from parents written record
Administering Provider Gina Ricci
Substance Lot Number 8L4B3423
Substance Expiration Date 07/01/2014
Substance Manufacturer Name MedImmune, LLC
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Gina Ricci

 Vaccine Administration Information - 27
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 07/15/2015
Administered Amount 0.2
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 8L4B3521
Substance Expiration Date 08/15/2015
Substance Manufacturer Name MedImmune,LLC
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Observations
Element Data
VIS Publication Date 08/19/2014
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig

 Vaccine Administration Information - 28
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 11/04/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9553IN2243
Substance Expiration Date 04/30/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 29
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 11/23/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT33
Substance Expiration Date 01/24/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 30
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 05/23/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT48
Substance Expiration Date 09/11/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

 Vaccine Administration Information - 31
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 10/23/2010
Administered Amount 999
Administered Units
Administration Notes historical
Administering Provider J Martinez
Substance Lot Number 7W27V7491
Substance Expiration Date 12/15/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

 Vaccine Administration Information - 32
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 11/22/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7W87V3452
Substance Expiration Date 04/13/2013
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

 Vaccine Administration Information - 33
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 07/15/2015
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 7W87V3687
Substance Expiration Date 07/15/2015
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Observations
Element Data
VIS Publication Date 05/21/2010
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig

4.1.2. Receive Acknowledgement

Test Step Type: TA_RESPONDER
No Description

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator | Profile Fixed
MSH.2 Encoding Characters ^~\& Profile Fixed
MSH.3 Sending Application
MSH.3.1 Namespace ID NIST APP Test Case Fixed
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID NIST Test Iz Reg Test Case Fixed
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID Test EHR Application Test Case Fixed
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID X68 Test Case Fixed
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 200906040000-0500 System Generated
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID NIST-IZ-ACK-001.01 Test Case Fixed
MSH.11 Processing ID
MSH.11.1 Processing ID T Test Case Fixed
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1 Profile Fixed
MSH.15 Accept Acknowledgment Type NE Profile Fixed
MSH.16 Application Acknowledgment Type NE Profile Fixed
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23 Profile Fixed
MSH.21.2 Namespace ID CDCPHINVS Profile Fixed
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA Test Case Fixed
MSA.2 Message Control ID NIST-IZ-001.01 Test Case Fixed

Location Data Element Data Categorization
MSH.1 Field Separator | Profile Fixed
MSH.2 Encoding Characters ^~\& Profile Fixed
MSH.3 Sending Application
MSH.3.1 Namespace ID NIST APP Test Case Fixed
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID NIST Test Iz Reg Test Case Fixed
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID Test EHR Application Test Case Fixed
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID X68 Test Case Fixed
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 200906040000-0500 System Generated
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID NIST-IZ-ACK-001.01 Test Case Fixed
MSH.11 Processing ID
MSH.11.1 Processing ID T Test Case Fixed
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1 Profile Fixed
MSH.15 Accept Acknowledgment Type NE Profile Fixed
MSH.16 Application Acknowledgment Type NE Profile Fixed
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23 Profile Fixed
MSH.21.2 Namespace ID CDCPHINVS Profile Fixed
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA Test Case Fixed
MSA.2 Message Control ID NIST-IZ-001.01 Test Case Fixed

4.1.3. Record an adverse reaction

Test Step Type: SUT_MANUAL
The Provider records in the EMR an adverse reaction of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose.

Test Story

Description

Following the vaccine administration, the patient's mother reports that the patient that evening had persistent, inconsolable crying lasting > 3 hours.

Comments

No Comments

PreCondition

The vaccinations for the visit have been administered.

PostCondition

The adverse reaction to the MMRV  of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR.

Test Objectives

Identify Adverse Event: The EHR or other clinical software system enables capture of structured data regarding adverse events.

Evaluation Criteria

Verify that vendor can record the adverse reaction of  persistent, inconsolable crying lasting > 3 hours within 48 hours of dose correctly and without omission

Notes to Testers

No Note

4.1.4. Transmit the updated vaccination report with adverse reaction to the registry

Test Step Type: SUT_INITIATOR
The EMR generates a Z22 Send Unsolicited Immunization Update Using a VXU correctly and without omission according to supplied test data.

Test Story

Description

The adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is reported to the Immunization Registry using a Z22/VXU message.

Comments

No Comments

PreCondition

An adverse reaction to the MMRV of persistent, inconsolable crying lasting > 3 hours within 48 hours of dose is recorded in the EMR.

PostCondition

The adverse reaction has been transmitted to the IIS.

Test Objectives

Transmit Standard Patient Immunization History Report: The EHR or other clinical software system directly or indirectly through an intermediary creates and transmits a report of a patient's immunization history to public health immunization registries.

Evaluation Criteria

The VXU/Z22 message passes validation using the NIST Immunization VXU Validation Tool (Z22) (context-free). The content of the message correctly reflects the test data (context-based) in accordance with the Test Data Specification and the Message Content.

Notes to Testers

No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID Test EHR Application
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID X68
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID NIST Test Iz Reg
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20120701082240-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID NIST-IZ-001.02
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

PID
Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 123456
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.3 Patient Identifier List
PID.3.1 ID Number 987633
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYIIS
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code SR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Gonzales Test Case Fixed
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Juana Test Case Fixed
PID.5.3 Second and Further Given Names or Initials Thereof Mariana Test Case Fixed
PID.5.7 Name Type Code L Test Case Fixed
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname Acosta Test Case Fixed
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code M Test Case Fixed
PID.7 Date/Time of Birth
PID.7.1 Time 200912231105 Test Case Fixed
PID.8 Administrative Sex F Test Case Fixed
PID.10 Race
PID.10.1 Identifier 2131-1 Test Case Fixed
PID.10.2 Text Other Race Test Case Fixed
PID.10.3 Name of Coding System HL70005 Test Case Fixed
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 4345 Standish Way Test Case Fixed
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Stamford Test Case Fixed
PID.11.4 State or Province CT Test Case Fixed
PID.11.5 Zip or Postal Code 06903 Test Case Fixed
PID.11.6 Country USA Test Case Fixed
PID.11.7 Address Type L Test Case Fixed
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 325 Shorline Drive
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Stamford
PID.11.4 State or Province CT Test Case Fixed
PID.11.5 Zip or Postal Code 06901
PID.11.6 Country
PID.11.7 Address Type BDL Test Case Fixed
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN Test Case Fixed
PID.13.3 Telecommunication Equipment Type PH Test Case Fixed
PID.13.4 Email Address
PID.13.6 Area/City Code 203 Test Case Fixed
PID.13.7 Local Number 5551212 Test Case Fixed
PID.22 Ethnic Group
PID.22.1 Identifier 2135-2 Test Case Fixed
PID.22.2 Text Hispanic or Latino Test Case Fixed
PID.22.3 Name of Coding System CDCREC Test Case Fixed
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator
PID.25 Birth Order
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator

PD1
Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 02
PD1.11.2 Text Reminder/Recall - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator
PD1.13 Protection Indicator Effective Date
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20120701
PD1.18 Publicity Code Effective Date 20120701

NK1
Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Gonzales
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Joanna Test Case Fixed
NK1.2.3 Second and Further Given Names or Initials Thereof Merida Test Case Fixed
NK1.2.7 Name Type Code L Test Case Fixed
NK1.3 Relationship
NK1.3.1 Identifier GRP Test Case Fixed
NK1.3.2 Text Grandparent Test Case Fixed
NK1.3.3 Name of Coding System HL70063 Test Case Fixed
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 4345 Standish Way Test Case Fixed
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Stamford Test Case Fixed
NK1.4.4 State or Province CT Test Case Fixed
NK1.4.5 Zip or Postal Code 06901 Test Case Fixed
NK1.4.6 Country
NK1.4.7 Address Type L Test Case Fixed
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN Test Case Fixed
NK1.5.3 Telecommunication Equipment Type PH Test Case Fixed
NK1.5.4 Email Address
NK1.5.6 Area/City Code 203 Test Case Fixed
NK1.5.7 Local Number 5551212 Test Case Fixed

ORC[*]
ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Sirtis
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lisa
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Carter
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Jane
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SH
ORC.17.2 Text Shoreline Hospital
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 6
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L Test Case Fixed
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 7
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 8
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Rodriguez
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name J
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 9
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 10
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 11
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 12
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 13
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 14
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 15
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Rodriguez
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name J
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 16
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 9999
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 17
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 18
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 19
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 20
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 21
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 22
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 23
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 24
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 25
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 26
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Ricci
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Gina
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 27
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 28
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 29
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 30
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name F
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 31
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name F
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 32
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name F
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 33
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina Test Case Fixed
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra Test Case Fixed
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith Test Case Fixed
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank Test Case Fixed
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L Test Case Fixed
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics Test Case Fixed
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA[*]
RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091123
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Sirtis
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lisa
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6332FK33
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101214
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100115
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text hepatitis B vaccine, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Immunization
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6352FK1
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101001
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101030
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6352FK24
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120831
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 107
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS2341
RXA.16 Substance Expiration Date
RXA.16.1 Time 20111130
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS2433
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110904
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 6
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS3255
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101201
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 7
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS249
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110301
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 8
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20140831
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 02
RXA.9.2 Text Historical information - from other provider
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Casera
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Linda
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D643QS8243
RXA.16 Substance Expiration Date
RXA.16.1 Time 20140901
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 9
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M54K9245
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100324
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 10
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M55K3342
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101030
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 11
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M75K4566
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100523
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 12
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M53K5534
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110222
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 13
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D333PV2431
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101004
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 14
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D333PV4344
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100323
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 15
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 02
RXA.9.2 Text Historical information - from other provider
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Casera
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Linda
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D335PV9644
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110222
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 16
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150519
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier 00
RXA.18.2 Text Parental decision
RXA.18.3 Name of Coding System NIP002
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status RE
RXA.21 Action Code - RXA A

RXA - 17
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100121
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P243V3281
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100130
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 18
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P343V8321
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100330
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 19
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P853V2164
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100830
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 20
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P853V58532
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110418
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 21
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RV533
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100215
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 22
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RV932
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100510
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 23
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100925
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D8043IN8734
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110312
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 24
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101027
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D8043IN8734
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110312
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 25
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111002
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D9334IN9333
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120522
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 26
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20131015
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 03
RXA.9.2 Text Historical information - from parents written record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Ricci
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Gina
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 8L4B3423
RXA.16 Substance Expiration Date
RXA.16.1 Time 20140701
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MED
RXA.17.2 Text MedImmune, LLC
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 27
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150715
RXA.5 Administered Code
RXA.5.1 Identifier 149
RXA.5.2 Text influenza, live, intranasal, quadrivalent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FluMist Quadrivalent
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.2
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 8L4B3521
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150815
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MED
RXA.17.2 Text MedImmune,LLC
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 28
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20121104
RXA.5 Administered Code
RXA.5.1 Identifier 149
RXA.5.2 Text influenza, live, intranasal, quadrivalent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FluMist Quadrivalent
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D9553IN2243
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120430
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 29
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111123
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RT33
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120124
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 30
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20120523
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RT48
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120911
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 31
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101023
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7W27V7491
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101215
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 32
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20121122
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7W87V3452
RXA.16 Substance Expiration Date
RXA.16.1 Time 20130413
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 33
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150715
RXA.5 Administered Code
RXA.5.1 Identifier 94 Test Case Fixed
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine Test Case Fixed
RXA.5.3 Name of Coding System CVX Test Case Fixed
RXA.5.5 Alternate Text ProQuad Test Case Fixed
RXA.5.6 Name of Alternate Coding System NDC Test Case Fixed
RXA.6 Administered Amount 0.5 Test Case Fixed
RXA.7 Administered Units
RXA.7.1 Identifier mL Test Case Fixed
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM Test Case Fixed
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00 Test Case Fixed
RXA.9.2 Text New immunization record Test Case Fixed
RXA.9.3 Name of Coding System NIP001 Test Case Fixed
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina Test Case Fixed
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra Test Case Fixed
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7W87V3687 Test Case Fixed
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150715 Test Case Fixed
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD Test Case Fixed
RXA.17.2 Text Merck Sharp \T\ Dohme Corp Test Case Fixed
RXA.17.3 Name of Coding System MVX Test Case Fixed
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP Test Case Fixed
RXA.21 Action Code - RXA A

RXR[*]
RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 3
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 4
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 5
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 6
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 7
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 8
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 9
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 10
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 11
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 12
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 13
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 14
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 15
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 16
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 17
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 18
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 19
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 20
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 21
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 22
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 23
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 24
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 25
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38284
RXR.1.2 Text Nasal
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Nasal
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier BN
RXR.2.2 Text Bilateral Nares
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 26
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38284
RXR.1.2 Text Nasal
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Nasal
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier BN
RXR.2.2 Text Bilateral Nares
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 27
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 28
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 29
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 30
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 31
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 32
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299 Test Case Fixed
RXR.1.2 Text Subcutaneous Test Case Fixed
RXR.1.3 Name of Coding System NCIT Test Case Fixed
RXR.1.5 Alternate Text Subcutaneous Test Case Fixed
RXR.1.6 Name of Alternate Coding System HL70162 Test Case Fixed
RXR.2 Administration Site
RXR.2.1 Identifier LD Test Case Fixed
RXR.2.2 Text Left Deltoid Test Case Fixed
RXR.2.3 Name of Coding System HL70163 Test Case Fixed
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX[*]
OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 21
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 31044-1
OBX.3.2 Text Reaction
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100522
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20140819
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS Presentation Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20150715
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text vaccine fund pgm elig cat
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20100521
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS Presentation Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20150715
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text vaccine fund pgm elig cat
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text vaccine fund pgm elig cat
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 21
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 31044-1 Test Case Fixed
OBX.3.2 Text Reaction Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Location Data Element Data Categorization
MSH.1 Field Separator |
MSH.2 Encoding Characters ^~\&
MSH.3 Sending Application
MSH.3.1 Namespace ID Test EHR Application
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID X68
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID NIST Test Iz Reg
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 20120701082240-0500
MSH.9 Message Type
MSH.9.1 Message Code VXU
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure VXU_V04
MSH.10 Message Control ID NIST-IZ-001.02
MSH.11 Processing ID
MSH.11.1 Processing ID P
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1
MSH.15 Accept Acknowledgment Type ER
MSH.16 Application Acknowledgment Type AL
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z22
MSH.21.2 Namespace ID CDCPHINVS
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
PID.1 Set ID - PID 1
PID.3 Patient Identifier List
PID.3.1 ID Number 123456
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYEHR
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code MR
PID.3 Patient Identifier List
PID.3.1 ID Number 987633
PID.3.3 Check Digit Scheme
PID.3.4 Assigning Authority
PID.3.4.1 Namespace ID MYIIS
PID.3.4.2 Universal ID
PID.3.4.3 Universal ID Type
PID.3.5 Identifier Type Code SR
PID.5 Patient Name
PID.5.1 Family Name
PID.5.1.1 Surname Gonzales Test Case Fixed
PID.5.1.2 Own Surname Prefix
PID.5.1.3 Own Surname
PID.5.1.4 Surname Prefix From Partner/Spouse
PID.5.1.5 Surname From Partner/Spouse
PID.5.2 Given Name Juana Test Case Fixed
PID.5.3 Second and Further Given Names or Initials Thereof Mariana Test Case Fixed
PID.5.7 Name Type Code L Test Case Fixed
PID.6 Mother's Maiden Name
PID.6.1 Family Name
PID.6.1.1 Surname Acosta Test Case Fixed
PID.6.1.2 Own Surname Prefix
PID.6.1.3 Own Surname
PID.6.1.4 Surname Prefix From Partner/Spouse
PID.6.1.5 Surname From Partner/Spouse
PID.6.7 Name Type Code M Test Case Fixed
PID.7 Date/Time of Birth
PID.7.1 Time 200912231105 Test Case Fixed
PID.8 Administrative Sex F Test Case Fixed
PID.10 Race
PID.10.1 Identifier 2131-1 Test Case Fixed
PID.10.2 Text Other Race Test Case Fixed
PID.10.3 Name of Coding System HL70005 Test Case Fixed
PID.10.5 Alternate Text
PID.10.6 Name of Alternate Coding System
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 4345 Standish Way Test Case Fixed
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Stamford Test Case Fixed
PID.11.4 State or Province CT Test Case Fixed
PID.11.5 Zip or Postal Code 06903 Test Case Fixed
PID.11.6 Country USA Test Case Fixed
PID.11.7 Address Type L Test Case Fixed
PID.11 Patient Address
PID.11.1 Street Address
PID.11.1.1 Street or Mailing Address 325 Shorline Drive
PID.11.1.2 Street Name
PID.11.1.3 Dwelling Number
PID.11.2 Other Designation
PID.11.3 City Stamford
PID.11.4 State or Province CT Test Case Fixed
PID.11.5 Zip or Postal Code 06901
PID.11.6 Country
PID.11.7 Address Type BDL Test Case Fixed
PID.13 Phone Number - Home
PID.13.2 Telecommunication Use Code PRN Test Case Fixed
PID.13.3 Telecommunication Equipment Type PH Test Case Fixed
PID.13.4 Email Address
PID.13.6 Area/City Code 203 Test Case Fixed
PID.13.7 Local Number 5551212 Test Case Fixed
PID.22 Ethnic Group
PID.22.1 Identifier 2135-2 Test Case Fixed
PID.22.2 Text Hispanic or Latino Test Case Fixed
PID.22.3 Name of Coding System CDCREC Test Case Fixed
PID.22.5 Alternate Text
PID.22.6 Name of Alternate Coding System
PID.24 Multiple Birth Indicator
PID.25 Birth Order
PID.29 Patient Death Date and Time
PID.29.1 Time
PID.30 Patient Death Indicator

Location Data Element Data Categorization
PD1.11 Publicity Code
PD1.11.1 Identifier 02
PD1.11.2 Text Reminder/Recall - any method
PD1.11.3 Name of Coding System HL70215
PD1.11.5 Alternate Text
PD1.11.6 Name of Alternate Coding System
PD1.12 Protection Indicator
PD1.13 Protection Indicator Effective Date
PD1.16 Immunization Registry Status A
PD1.17 Immunization Registry Status Effective Date 20120701
PD1.18 Publicity Code Effective Date 20120701

Location Data Element Data Categorization
NK1.1 Set ID - NK1 1
NK1.2 Name
NK1.2.1 Family Name
NK1.2.1.1 Surname Gonzales
NK1.2.1.2 Own Surname Prefix
NK1.2.1.3 Own Surname
NK1.2.1.4 Surname Prefix From Partner/Spouse
NK1.2.1.5 Surname From Partner/Spouse
NK1.2.2 Given Name Joanna Test Case Fixed
NK1.2.3 Second and Further Given Names or Initials Thereof Merida Test Case Fixed
NK1.2.7 Name Type Code L Test Case Fixed
NK1.3 Relationship
NK1.3.1 Identifier GRP Test Case Fixed
NK1.3.2 Text Grandparent Test Case Fixed
NK1.3.3 Name of Coding System HL70063 Test Case Fixed
NK1.3.5 Alternate Text
NK1.3.6 Name of Alternate Coding System
NK1.4 Address
NK1.4.1 Street Address
NK1.4.1.1 Street or Mailing Address 4345 Standish Way Test Case Fixed
NK1.4.1.2 Street Name
NK1.4.1.3 Dwelling Number
NK1.4.2 Other Designation
NK1.4.3 City Stamford Test Case Fixed
NK1.4.4 State or Province CT Test Case Fixed
NK1.4.5 Zip or Postal Code 06901 Test Case Fixed
NK1.4.6 Country
NK1.4.7 Address Type L Test Case Fixed
NK1.5 Phone Number
NK1.5.2 Telecommunication Use Code PRN Test Case Fixed
NK1.5.3 Telecommunication Equipment Type PH Test Case Fixed
NK1.5.4 Email Address
NK1.5.6 Area/City Code 203 Test Case Fixed
NK1.5.7 Local Number 5551212 Test Case Fixed

ORC - 1
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Sirtis
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Lisa
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Carter
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Jane
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SH
ORC.17.2 Text Shoreline Hospital
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 2
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 3
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 4
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 5
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 6
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L Test Case Fixed
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 7
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 8
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Rodriguez
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name J
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 9
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 10
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 11
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 12
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 13
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 14
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 15
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Rodriguez
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name J
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 16
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 9999
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 17
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 18
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 19
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 20
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 21
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 22
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 23
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 24
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 25
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 26
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Ricci
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Gina
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 27
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 28
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 29
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Herrera
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Carlos
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 30
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name F
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 31
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name F
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 32
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Martinez
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name J
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name F
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier OP
ORC.17.2 Text Oceanview Pediatrics
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

ORC - 33
Location Data Element Data Categorization
ORC.1 Order Control RE
ORC.2 Placer Order Number
ORC.2.1 Entity Identifier
ORC.2.2 Namespace ID
ORC.2.3 Universal ID
ORC.2.4 Universal ID Type
ORC.3 Filler Order Number
ORC.3.1 Entity Identifier 197027
ORC.3.2 Namespace ID DCS
ORC.3.3 Universal ID
ORC.3.4 Universal ID Type
ORC.10 Entered By
ORC.10.1 ID Number
ORC.10.2 Family Name
ORC.10.2.1 Surname Molina Test Case Fixed
ORC.10.2.2 Own Surname Prefix
ORC.10.2.3 Own Surname
ORC.10.2.4 Surname Prefix From Partner/Spouse
ORC.10.2.5 Surname From Partner/Spouse
ORC.10.3 Given Name Sandra Test Case Fixed
ORC.10.4 Second and Further Given Names or Initials Thereof
ORC.10.9 Assigning Authority
ORC.10.9.1 Namespace ID
ORC.10.9.2 Universal ID
ORC.10.9.3 Universal ID Type
ORC.10.10 Name Type Code
ORC.10.12 Check Digit Scheme
ORC.10.13 Identifier Type Code
ORC.12 Ordering Provider
ORC.12.1 ID Number
ORC.12.2 Family Name
ORC.12.2.1 Surname Smith Test Case Fixed
ORC.12.2.2 Own Surname Prefix
ORC.12.2.3 Own Surname
ORC.12.2.4 Surname Prefix From Partner/Spouse
ORC.12.2.5 Surname From Partner/Spouse
ORC.12.3 Given Name Frank Test Case Fixed
ORC.12.4 Second and Further Given Names or Initials Thereof
ORC.12.9 Assigning Authority
ORC.12.9.1 Namespace ID
ORC.12.9.2 Universal ID
ORC.12.9.3 Universal ID Type
ORC.12.10 Name Type Code L Test Case Fixed
ORC.12.12 Check Digit Scheme
ORC.12.13 Identifier Type Code
ORC.17 Entering Organization
ORC.17.1 Identifier SP
ORC.17.2 Text Shoreline Pediatrics Test Case Fixed
ORC.17.3 Name of Coding System HL70362
ORC.17.5 Alternate Text
ORC.17.6 Name of Alternate Coding System

RXA - 1
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20091123
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Sirtis
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Lisa
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6332FK33
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101214
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 2
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100115
RXA.5 Administered Code
RXA.5.1 Identifier 45
RXA.5.2 Text hepatitis B vaccine, unspecified formulation
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text Historical Immunization
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6352FK1
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101001
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 3
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101030
RXA.5 Administered Code
RXA.5.1 Identifier 08
RXA.5.2 Text hepatitis B vaccine, pediatric or pediatric/adolescent dosage
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ENGERIX-B
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6352FK24
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120831
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 4
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 107
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS2341
RXA.16 Substance Expiration Date
RXA.16.1 Time 20111130
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 5
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS2433
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110904
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 6
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS3255
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101201
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 7
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D409QS249
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110301
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 8
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20140831
RXA.5 Administered Code
RXA.5.1 Identifier 106
RXA.5.2 Text diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text DAPTACEL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 02
RXA.9.2 Text Historical information - from other provider
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Casera
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Linda
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D643QS8243
RXA.16 Substance Expiration Date
RXA.16.1 Time 20140901
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 9
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M54K9245
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100324
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 10
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M55K3342
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101030
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 11
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M75K4566
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100523
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 12
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 49
RXA.5.2 Text Haemophilus influenzae type b vaccine, PRP-OMP conjugate
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PedvaxHIB
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7M53K5534
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110222
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 13
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D333PV2431
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101004
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 14
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D333PV4344
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100323
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 15
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text IPOL
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 02
RXA.9.2 Text Historical information - from other provider
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Casera
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Linda
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D335PV9644
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110222
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi Pasteur Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 16
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150519
RXA.5 Administered Code
RXA.5.1 Identifier 10
RXA.5.2 Text poliovirus vaccine, inactivated
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text
RXA.5.6 Name of Alternate Coding System
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier
RXA.9.2 Text
RXA.9.3 Name of Coding System
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number
RXA.16 Substance Expiration Date
RXA.16.1 Time
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier
RXA.17.2 Text
RXA.17.3 Name of Coding System
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier 00
RXA.18.2 Text Parental decision
RXA.18.3 Name of Coding System NIP002
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status RE
RXA.21 Action Code - RXA A

RXA - 17
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100121
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P243V3281
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100130
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 18
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P343V8321
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100330
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 19
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100522
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P853V2164
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100830
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 20
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20110221
RXA.5 Administered Code
RXA.5.1 Identifier 133
RXA.5.2 Text pneumococcal conjugate vaccine, 13 valent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text PREVNAR 13
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number P853V58532
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110418
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PFR
RXA.17.2 Text Pfizer, Inc
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 21
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100122
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RV533
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100215
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 22
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100323
RXA.5 Administered Code
RXA.5.1 Identifier 119
RXA.5.2 Text rotavirus, live, monovalent vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ROTARIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RV932
RXA.16 Substance Expiration Date
RXA.16.1 Time 20100510
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 23
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20100925
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D8043IN8734
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110312
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 24
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101027
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D8043IN8734
RXA.16 Substance Expiration Date
RXA.16.1 Time 20110312
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 25
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111002
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D9334IN9333
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120522
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 26
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20131015
RXA.5 Administered Code
RXA.5.1 Identifier 161
RXA.5.2 Text Influenza, injectable,quadrivalent, preservative free, pediatric
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FLUZONE QUADRIVALENT
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 03
RXA.9.2 Text Historical information - from parents written record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Ricci
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Gina
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 8L4B3423
RXA.16 Substance Expiration Date
RXA.16.1 Time 20140701
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MED
RXA.17.2 Text MedImmune, LLC
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 27
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150715
RXA.5 Administered Code
RXA.5.1 Identifier 149
RXA.5.2 Text influenza, live, intranasal, quadrivalent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FluMist Quadrivalent
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 0.2
RXA.7 Administered Units
RXA.7.1 Identifier mL
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00
RXA.9.2 Text New immunization record
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 8L4B3521
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150815
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MED
RXA.17.2 Text MedImmune,LLC
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 28
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20121104
RXA.5 Administered Code
RXA.5.1 Identifier 149
RXA.5.2 Text influenza, live, intranasal, quadrivalent
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text FluMist Quadrivalent
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number D9553IN2243
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120430
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 29
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20111123
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RT33
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120124
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier SKB
RXA.17.2 Text GlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 30
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20120523
RXA.5 Administered Code
RXA.5.1 Identifier 83
RXA.5.2 Text hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text HAVRIX
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 6359RT48
RXA.16 Substance Expiration Date
RXA.16.1 Time 20120911
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier PMC
RXA.17.2 Text Sanofi PasteurGlaxoSmithKline Biologicals SA
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 31
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20101023
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 01
RXA.9.2 Text historical
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7W27V7491
RXA.16 Substance Expiration Date
RXA.16.1 Time 20101215
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 32
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20121122
RXA.5 Administered Code
RXA.5.1 Identifier 94
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine
RXA.5.3 Name of Coding System CVX
RXA.5.5 Alternate Text ProQuad
RXA.5.6 Name of Alternate Coding System NDC
RXA.6 Administered Amount 999
RXA.7 Administered Units
RXA.7.1 Identifier
RXA.7.2 Text
RXA.7.3 Name of Coding System
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 08
RXA.9.2 Text Historical information - from public agency
RXA.9.3 Name of Coding System NIP001
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Martinez
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name J
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7W87V3452
RXA.16 Substance Expiration Date
RXA.16.1 Time 20130413
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD
RXA.17.2 Text Merck Sharp \T\ Dohme Corp
RXA.17.3 Name of Coding System MVX
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP
RXA.21 Action Code - RXA A

RXA - 33
Location Data Element Data Categorization
RXA.1 Give Sub-ID Counter 0
RXA.2 Administration Sub-ID Counter 1
RXA.3 Date/Time Start of Administration
RXA.3.1 Time 20150715
RXA.5 Administered Code
RXA.5.1 Identifier 94 Test Case Fixed
RXA.5.2 Text measles, mumps, rubella, and varicella virus vaccine Test Case Fixed
RXA.5.3 Name of Coding System CVX Test Case Fixed
RXA.5.5 Alternate Text ProQuad Test Case Fixed
RXA.5.6 Name of Alternate Coding System NDC Test Case Fixed
RXA.6 Administered Amount 0.5 Test Case Fixed
RXA.7 Administered Units
RXA.7.1 Identifier mL Test Case Fixed
RXA.7.2 Text
RXA.7.3 Name of Coding System UCUM Test Case Fixed
RXA.7.5 Alternate Text
RXA.7.6 Name of Alternate Coding System
RXA.9 Administration Notes
RXA.9.1 Identifier 00 Test Case Fixed
RXA.9.2 Text New immunization record Test Case Fixed
RXA.9.3 Name of Coding System NIP001 Test Case Fixed
RXA.9.5 Alternate Text
RXA.9.6 Name of Alternate Coding System
RXA.10 Administering Provider
RXA.10.1 ID Number
RXA.10.2 Family Name
RXA.10.2.1 Surname Molina Test Case Fixed
RXA.10.2.2 Own Surname Prefix
RXA.10.2.3 Own Surname
RXA.10.2.4 Surname Prefix From Partner/Spouse
RXA.10.2.5 Surname From Partner/Spouse
RXA.10.3 Given Name Sandra Test Case Fixed
RXA.10.4 Second and Further Given Names or Initials Thereof
RXA.10.9 Assigning Authority
RXA.10.9.1 Namespace ID
RXA.10.9.2 Universal ID
RXA.10.9.3 Universal ID Type
RXA.10.10 Name Type Code
RXA.10.12 Check Digit Scheme
RXA.10.13 Identifier Type Code
RXA.11 Administered-at Location
RXA.11.4 Facility
RXA.11.4.1 Namespace ID DCS_DC
RXA.11.4.2 Universal ID
RXA.11.4.3 Universal ID Type
RXA.15 Substance Lot Number 7W87V3687 Test Case Fixed
RXA.16 Substance Expiration Date
RXA.16.1 Time 20150715 Test Case Fixed
RXA.17 Substance Manufacturer Name
RXA.17.1 Identifier MSD Test Case Fixed
RXA.17.2 Text Merck Sharp \T\ Dohme Corp Test Case Fixed
RXA.17.3 Name of Coding System MVX Test Case Fixed
RXA.17.5 Alternate Text
RXA.17.6 Name of Alternate Coding System
RXA.18 Substance/Treatment Refusal Reason
RXA.18.1 Identifier
RXA.18.2 Text
RXA.18.3 Name of Coding System
RXA.18.5 Alternate Text
RXA.18.6 Name of Alternate Coding System
RXA.20 Completion Status CP Test Case Fixed
RXA.21 Action Code - RXA A

RXR - 1
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 2
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 3
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 4
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 5
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 6
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 7
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 8
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 9
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 10
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 11
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 12
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 13
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 14
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 15
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 16
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 17
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text SC
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 18
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 19
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 20
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 21
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 22
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LT
RXR.2.2 Text Left Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 23
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RT
RXR.2.2 Text Right Thigh
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 24
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 25
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38284
RXR.1.2 Text Nasal
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Nasal
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier BN
RXR.2.2 Text Bilateral Nares
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 26
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38284
RXR.1.2 Text Nasal
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Nasal
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier BN
RXR.2.2 Text Bilateral Nares
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 27
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 28
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier RD
RXR.2.2 Text Right Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 29
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C28161
RXR.1.2 Text IM
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text IM
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 30
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 31
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299
RXR.1.2 Text Subcutaneous
RXR.1.3 Name of Coding System NCIT
RXR.1.5 Alternate Text Subcutaneous
RXR.1.6 Name of Alternate Coding System HL70162
RXR.2 Administration Site
RXR.2.1 Identifier LD
RXR.2.2 Text Left Deltoid
RXR.2.3 Name of Coding System HL70163
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

RXR - 32
Location Data Element Data Categorization
RXR.1 Route
RXR.1.1 Identifier C38299 Test Case Fixed
RXR.1.2 Text Subcutaneous Test Case Fixed
RXR.1.3 Name of Coding System NCIT Test Case Fixed
RXR.1.5 Alternate Text Subcutaneous Test Case Fixed
RXR.1.6 Name of Alternate Coding System HL70162 Test Case Fixed
RXR.2 Administration Site
RXR.2.1 Identifier LD Test Case Fixed
RXR.2.2 Text Left Deltoid Test Case Fixed
RXR.2.3 Name of Coding System HL70163 Test Case Fixed
RXR.2.5 Alternate Text
RXR.2.6 Name of Alternate Coding System

OBX - 1
Location Data Element Data Categorization
OBX.1 Set ID - OBX 21
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 31044-1
OBX.3.2 Text Reaction
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20100522
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 2
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20140819
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 3
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS Presentation Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20150715
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 4
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text vaccine fund pgm elig cat
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 5
Location Data Element Data Categorization
OBX.1 Set ID - OBX 2
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29768-9
OBX.3.2 Text VIS Publication Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20100521
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 6
Location Data Element Data Categorization
OBX.1 Set ID - OBX 3
OBX.2 Value Type TS
OBX.3 Observation Identifier
OBX.3.1 Identifier 29769-7
OBX.3.2 Text VIS Presentation Date
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.5.1 Time 20150715
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 7
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text vaccine fund pgm elig cat
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 8
Location Data Element Data Categorization
OBX.1 Set ID - OBX 1
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 64994-7
OBX.3.2 Text vaccine fund pgm elig cat
OBX.3.3 Name of Coding System LN
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

OBX - 9
Location Data Element Data Categorization
OBX.1 Set ID - OBX 21
OBX.2 Value Type CE
OBX.3 Observation Identifier
OBX.3.1 Identifier 31044-1 Test Case Fixed
OBX.3.2 Text Reaction Test Case Fixed
OBX.3.3 Name of Coding System LN Test Case Fixed
OBX.3.5 Alternate Text
OBX.3.6 Name of Alternate Coding System
OBX.4 Observation Sub-ID 1
OBX.5 Observation Value
OBX.6 Units
OBX.6.1 Identifier
OBX.6.2 Text
OBX.6.3 Name of Coding System
OBX.6.5 Alternate Text
OBX.6.6 Name of Alternate Coding System
OBX.11 Observation Result Status F
OBX.14 Date/Time of the Observation
OBX.14.1 Time 20150715
OBX.17 Observation Method
OBX.17.1 Identifier
OBX.17.2 Text
OBX.17.3 Name of Coding System
OBX.17.5 Alternate Text
OBX.17.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Juana Mariana Gonzales
Mother's Maiden Name Maria Acosta
ID Number 123456 987633
Date/Time of Birth 12/23/2009
Administrative Sex Female
Patient Address 4345 Standish Way Stamford CT 06903 USA
Patient Address 1 325 Shorline Drive Stamford CT 06901
Local Number (203)555-1212
Race Other Race
Ethnic Group Hispanic or Latino
Birth Order
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 07/01/2012
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 07/01/2012
Protection Indicator
Protection Indicator Effective Date
Guardian or Responsible Party
Element Data
Name Joanna Merida Gonzales
Relationship Grandparent
Address 4345 Standish Way Stamford CT 06901
Phone Number (203)555-1212

Vaccine Administration Information[*]
Vaccine Administration Information - 1
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 11/23/2009
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Lisa Sirtis
Substance Lot Number 6332FK33
Substance Expiration Date 12/14/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

Vaccine Administration Information - 2
Element Data
Administered Code hepatitis B vaccine, unspecified formulation
Date/Time Start of Administration 01/15/2010
Administered Amount 999
Administered Units
Administration Notes Historical Immunization
Administering Provider Sandra Molina
Substance Lot Number 6352FK1
Substance Expiration Date 10/01/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information - 3
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 10/30/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6352FK24
Substance Expiration Date 08/31/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 4
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2341
Substance Expiration Date 11/30/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 5
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2433
Substance Expiration Date 09/04/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 6
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS3255
Substance Expiration Date 12/01/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data
Reaction fever of >40.5C (105F) within 48 hours of dose

Vaccine Administration Information - 7
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS249
Substance Expiration Date 03/01/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 8
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 08/31/2014
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D643QS8243
Substance Expiration Date 09/01/2014
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information - 9
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M54K9245
Substance Expiration Date 03/24/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 10
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M55K3342
Substance Expiration Date 10/30/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 11
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M75K4566
Substance Expiration Date 05/23/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 12
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M53K5534
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 13
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV2431
Substance Expiration Date 10/04/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 14
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV4344
Substance Expiration Date 03/23/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 15
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D335PV9644
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

Vaccine Administration Information - 16
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 05/19/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Completion Status RE
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Vaccine Administration Information - 17
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/21/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P243V3281
Substance Expiration Date 01/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 18
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P343V8321
Substance Expiration Date 03/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 19
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V2164
Substance Expiration Date 08/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 20
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V58532
Substance Expiration Date 04/18/2011
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 21
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV533
Substance Expiration Date 02/15/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 22
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV932
Substance Expiration Date 05/10/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 23
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 09/25/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 24
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/27/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 25
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/02/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9334IN9333
Substance Expiration Date 05/22/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 26
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/15/2013
Administered Amount 999
Administered Units
Administration Notes Historical information - from parents written record
Administering Provider Gina Ricci
Substance Lot Number 8L4B3423
Substance Expiration Date 07/01/2014
Substance Manufacturer Name MedImmune, LLC
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Gina Ricci

Vaccine Administration Information - 27
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 07/15/2015
Administered Amount 0.2
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 8L4B3521
Substance Expiration Date 08/15/2015
Substance Manufacturer Name MedImmune,LLC
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Observations
Element Data
VIS Publication Date 08/19/2014
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig

Vaccine Administration Information - 28
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 11/04/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9553IN2243
Substance Expiration Date 04/30/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 29
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 11/23/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT33
Substance Expiration Date 01/24/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Vaccine Administration Information - 30
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 05/23/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT48
Substance Expiration Date 09/11/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information - 31
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 10/23/2010
Administered Amount 999
Administered Units
Administration Notes historical
Administering Provider J Martinez
Substance Lot Number 7W27V7491
Substance Expiration Date 12/15/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information - 32
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 11/22/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7W87V3452
Substance Expiration Date 04/13/2013
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

Vaccine Administration Information - 33
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 07/15/2015
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 7W87V3687
Substance Expiration Date 07/15/2015
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Observations
Element Data
VIS Publication Date 05/21/2010
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig
vaccine fund pgm elig cat Not VFC elig
Reaction persistent, inconsolable crying lasting > 3 hours within 48 hours of dose
Element Data
Patient Name Juana Mariana Gonzales
Mother's Maiden Name Maria Acosta
ID Number 123456 987633
Date/Time of Birth 12/23/2009
Administrative Sex Female
Patient Address 4345 Standish Way Stamford CT 06903 USA
Patient Address 1 325 Shorline Drive Stamford CT 06901
Local Number (203)555-1212
Race Other Race
Ethnic Group Hispanic or Latino
Birth Order
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 07/01/2012
Publicity Code Reminder/Recall - any method
Publicity Code Effective Date 07/01/2012
Protection Indicator
Protection Indicator Effective Date
Element Data
Name Joanna Merida Gonzales
Relationship Grandparent
Address 4345 Standish Way Stamford CT 06901
Phone Number (203)555-1212
Vaccine Administration Information - 1
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 11/23/2009
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider Lisa Sirtis
Substance Lot Number 6332FK33
Substance Expiration Date 12/14/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Shoreline Hospital
Entered By Lisa Sirtis
Ordered By Jane Carter

 Vaccine Administration Information - 2
Element Data
Administered Code hepatitis B vaccine, unspecified formulation
Date/Time Start of Administration 01/15/2010
Administered Amount 999
Administered Units
Administration Notes Historical Immunization
Administering Provider Sandra Molina
Substance Lot Number 6352FK1
Substance Expiration Date 10/01/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

 Vaccine Administration Information - 3
Element Data
Administered Code hepatitis B vaccine, pediatric or pediatric/adolescent dosage
Date/Time Start of Administration 10/30/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6352FK24
Substance Expiration Date 08/31/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 4
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, unspecified
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2341
Substance Expiration Date 11/30/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 5
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS2433
Substance Expiration Date 09/04/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 6
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS3255
Substance Expiration Date 12/01/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

Historical information - from public agency
Element Data
Reaction fever of >40.5C (105F) within 48 hours of dose

 Vaccine Administration Information - 7
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D409QS249
Substance Expiration Date 03/01/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 8
Element Data
Administered Code diphtheria, tetanus toxoids and acellular pertussis vaccine, 5 pertussis
Date/Time Start of Administration 08/31/2014
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D643QS8243
Substance Expiration Date 09/01/2014
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

 Vaccine Administration Information - 9
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M54K9245
Substance Expiration Date 03/24/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 10
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M55K3342
Substance Expiration Date 10/30/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 11
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M75K4566
Substance Expiration Date 05/23/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 12
Element Data
Administered Code Haemophilus influenzae type b vaccine, PRP-OMP conjugate
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7M53K5534
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 13
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV2431
Substance Expiration Date 10/04/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 14
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D333PV4344
Substance Expiration Date 03/23/2010
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 15
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from other provider
Administering Provider Linda Casera
Substance Lot Number D335PV9644
Substance Expiration Date 02/22/2011
Substance Manufacturer Name Sanofi Pasteur Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By J Rodriguez

 Vaccine Administration Information - 16
Element Data
Administered Code poliovirus vaccine, inactivated
Date/Time Start of Administration 05/19/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Completion Status RE
Action Code Add
Route
Administration Site
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

 Vaccine Administration Information - 17
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 01/21/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P243V3281
Substance Expiration Date 01/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 18
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P343V8321
Substance Expiration Date 03/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route SC
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 19
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 05/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V2164
Substance Expiration Date 08/30/2010
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 20
Element Data
Administered Code pneumococcal conjugate vaccine, 13 valent
Date/Time Start of Administration 02/21/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number P853V58532
Substance Expiration Date 04/18/2011
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 21
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 01/22/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV533
Substance Expiration Date 02/15/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 22
Element Data
Administered Code rotavirus, live, monovalent vaccine
Date/Time Start of Administration 03/23/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RV932
Substance Expiration Date 05/10/2010
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 23
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 09/25/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 24
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/27/2010
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D8043IN8734
Substance Expiration Date 03/12/2011
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Thigh
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 25
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/02/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9334IN9333
Substance Expiration Date 05/22/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 26
Element Data
Administered Code Influenza, injectable,quadrivalent, preservative free, pediatric
Date/Time Start of Administration 10/15/2013
Administered Amount 999
Administered Units
Administration Notes Historical information - from parents written record
Administering Provider Gina Ricci
Substance Lot Number 8L4B3423
Substance Expiration Date 07/01/2014
Substance Manufacturer Name MedImmune, LLC
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Gina Ricci

 Vaccine Administration Information - 27
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 07/15/2015
Administered Amount 0.2
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 8L4B3521
Substance Expiration Date 08/15/2015
Substance Manufacturer Name MedImmune,LLC
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Nasal
Administration Site Bilateral Nares
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Observations
Element Data
VIS Publication Date 08/19/2014
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig

 Vaccine Administration Information - 28
Element Data
Administered Code influenza, live, intranasal, quadrivalent
Date/Time Start of Administration 11/04/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number D9553IN2243
Substance Expiration Date 04/30/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 29
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 11/23/2011
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT33
Substance Expiration Date 01/24/2012
Substance Manufacturer Name GlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Right Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By Carlos Herrera

 Vaccine Administration Information - 30
Element Data
Administered Code hepatitis A vaccine, pediatric/adolescent dosage, 2 dose schedule
Date/Time Start of Administration 05/23/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 6359RT48
Substance Expiration Date 09/11/2012
Substance Manufacturer Name Sanofi PasteurGlaxoSmithKline Biologicals SA
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route IM
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

 Vaccine Administration Information - 31
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 10/23/2010
Administered Amount 999
Administered Units
Administration Notes historical
Administering Provider J Martinez
Substance Lot Number 7W27V7491
Substance Expiration Date 12/15/2010
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

 Vaccine Administration Information - 32
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 11/22/2012
Administered Amount 999
Administered Units
Administration Notes Historical information - from public agency
Administering Provider J Martinez
Substance Lot Number 7W87V3452
Substance Expiration Date 04/13/2013
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Oceanview Pediatrics
Entered By J Martinez
Ordered By F Smith

 Vaccine Administration Information - 33
Element Data
Administered Code measles, mumps, rubella, and varicella virus vaccine
Date/Time Start of Administration 07/15/2015
Administered Amount 0.5
Administered Units
Administration Notes New immunization record
Administering Provider Sandra Molina
Substance Lot Number 7W87V3687
Substance Expiration Date 07/15/2015
Substance Manufacturer Name Merck Sharp \T\ Dohme Corp
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Deltoid
Entering Organization Shoreline Pediatrics
Entered By Sandra Molina
Ordered By Frank Smith

Observations
Element Data
VIS Publication Date 05/21/2010
VIS Presentation Date 07/15/2015
vaccine fund pgm elig cat Not VFC elig
vaccine fund pgm elig cat Not VFC elig
Reaction persistent, inconsolable crying lasting > 3 hours within 48 hours of dose

4.1.5. Receive Acknowledgement

Test Step Type: TA_RESPONDER
No Description

Test Story

Description
No Description

Comments
No Comments

PreCondition
No PreCondition

PostCondition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
No evaluation criteria

Notes to Testers
No Note

Message Contents

MSH
Location Data Element Data Categorization
MSH.1 Field Separator | Profile Fixed
MSH.2 Encoding Characters ^~\& Profile Fixed
MSH.3 Sending Application
MSH.3.1 Namespace ID NIST APP Test Case Fixed
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID NIST Test Iz Reg Test Case Fixed
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID Test EHR Application Test Case Fixed
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID X68 Test Case Fixed
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 200906040000-0500 System Generated
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID NIST-IZ-ACK-001.02 Test Case Fixed
MSH.11 Processing ID
MSH.11.1 Processing ID T Test Case Fixed
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1 Profile Fixed
MSH.15 Accept Acknowledgment Type NE Profile Fixed
MSH.16 Application Acknowledgment Type NE Profile Fixed
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23 Profile Fixed
MSH.21.2 Namespace ID CDCPHINVS Profile Fixed
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

MSA
Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA Test Case Fixed
MSA.2 Message Control ID NIST-IZ-001.02 Test Case Fixed

Location Data Element Data Categorization
MSH.1 Field Separator | Profile Fixed
MSH.2 Encoding Characters ^~\& Profile Fixed
MSH.3 Sending Application
MSH.3.1 Namespace ID NIST APP Test Case Fixed
MSH.3.2 Universal ID
MSH.3.3 Universal ID Type
MSH.4 Sending Facility
MSH.4.1 Namespace ID NIST Test Iz Reg Test Case Fixed
MSH.4.2 Universal ID
MSH.4.3 Universal ID Type
MSH.5 Receiving Application
MSH.5.1 Namespace ID Test EHR Application Test Case Fixed
MSH.5.2 Universal ID
MSH.5.3 Universal ID Type
MSH.6 Receiving Facility
MSH.6.1 Namespace ID X68 Test Case Fixed
MSH.6.2 Universal ID
MSH.6.3 Universal ID Type
MSH.7 Date/Time Of Message
MSH.7.1 Time 200906040000-0500 System Generated
MSH.9 Message Type
MSH.9.1 Message Code ACK
MSH.9.2 Trigger Event V04
MSH.9.3 Message Structure ACK
MSH.10 Message Control ID NIST-IZ-ACK-001.02 Test Case Fixed
MSH.11 Processing ID
MSH.11.1 Processing ID T Test Case Fixed
MSH.12 Version ID
MSH.12.1 Version ID 2.5.1 Profile Fixed
MSH.15 Accept Acknowledgment Type NE Profile Fixed
MSH.16 Application Acknowledgment Type NE Profile Fixed
MSH.21 Message Profile Identifier
MSH.21.1 Entity Identifier Z23 Profile Fixed
MSH.21.2 Namespace ID CDCPHINVS Profile Fixed
MSH.21.3 Universal ID
MSH.21.4 Universal ID Type
MSH.22 Sending Responsible Organization
MSH.22.1 Organization Name
MSH.22.6 Assigning Authority
MSH.22.6.1 Namespace ID
MSH.22.6.2 Universal ID
MSH.22.6.3 Universal ID Type
MSH.22.7 Identifier Type Code
MSH.22.10 Organization Identifier
MSH.23 Receiving Responsible Organization
MSH.23.1 Organization Name
MSH.23.6 Assigning Authority
MSH.23.6.1 Namespace ID
MSH.23.6.2 Universal ID
MSH.23.6.3 Universal ID Type
MSH.23.7 Identifier Type Code
MSH.23.10 Organization Identifier

Location Data Element Data Categorization
MSA.1 Acknowledgment Code AA Test Case Fixed
MSA.2 Message Control ID NIST-IZ-001.02 Test Case Fixed